Class 




Book.'Z-i ? 
Copyright^ . 



COPYRIGHT DEPOSfT. 



/ J 






ANSWERS 



TO 



Questions Prescribed 



BY 



Pental State Boards 



BY 



ROBERT B. LUDY, M. D. 



PHILADELPHIA, PA.: 

CONOVER PUBLISHING HOUSE, 

429 NORTH TENTH STREET, 
I902. 



> > 






THE LIBRARY »F 
GONGRr 

Two Copies Received 

APR. «g 1902 

COPYWaHT eNTRV 



5iU-. 



CUSS AyXXa No.. 

1- L 2 3, 9 

copy e. 






■V 



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Entered according to Act of Congress, in the year 1902, by 

Robert B. Ludy, M. D., 
in the Office of the Librarian of Congress at Washington. 



. • . . 



PREFACE. 



To pass creditable examinations is the laudable ambition of every 
earnest student. Many persons having an adequate knowledge of the 
subject in which they are tested, fail, because of their inability to inter- 
pret properly the intents and purposes of the questions to be answered 
by them. To aid in this, as well as to afford a convenient manual for 
the general preparation of Dental Students in their work, is the sole 
object of this book. 

Having collected a large number of questions from different States, 
it was found that duplications occurred ranging from 30% to 75%, vary- 
ing according to the several subjects. Thus a comprehensive knowledge 
of these questions and answers will serve excellently in the preparation 
for future examinations before such Boards. 

In order to secure a critical interpretation of the questions, and 
concise, yet complete, answers to the same, the author has been favored 
by the assistance of well-known specialists in their several lines, whose 
competence and experience give to the work a range and value impossi- 
ble of attainment in the product of a single author. 

It has been deemed advisable to unite all questions from the dif- 
ferent States under their respective headings,. so that undue repetitions 
of similar questions might be avoided. 

Although standard literature has necessarily been consulted, yet, in 
a work of this character, references would only prove cumbersome ; 
hence they have been generally omitted. 

To Drs. Rice, Greenbaum, Thomas, Newton, Boom, Buckley, Fritz 
and Good, the author makes grateful acknowledgement. The high 
value of their carefully prepared answers is fully appreciated by him, 
and will be, he is assured, by those into whose hands the work is com- 
mitted. The answers to the questions on " Special Dental Anatomy and 
Physiology," have been written by Dr. Herbst of Philadelphia. The 
author also desires to thank Dr. Roxby, Instructor in Anatomy at the 
Medico -Chirurgical College, for valuable assistance in the preparation of 
this work. 

Should the earnest students in Dentistry find aid herein in their 
efforts to succeed, the sincere wishes of the author shall be realised. 

R. B. LUDY. 

Philadelphia, April, 1902. 



SPECIAL AUTHORS- 
operative DENTISTRY.— By EARLE C RICE, D. D. S., 
Philadelphia. Professor of Dental Pathology, 
Therapeutics and Materia Medica in the Medico- 
Chirurgical College of Philadelphia(Department 
of Dentistry), 

and 
MAX GREENBAUM, D. D. S-, Philadelphia. 

PROSTHETIC DENTISTRY.— By Max GREENBAUM,D.D.S. 

ORAL SURGERY.— By W. HERSEY THOMAS, M. D., Phil- 
adelphia. Instructor in Surgery in the Medico- 
Chirurgical College of Philadelphia. 

PATHOLOGY and THERAPEUTICS— By EARLE C. Rice, 
D. D. S. 

PATHOLOGY.— By W. HERSEY THOMAS, M. D. 

flATERIA MEDICA and THERAPEUTICS.— By RODLEY 
D. NEWTON, Ph. G., M. D. Instructor in Anes- 
thesia and anesthetics in the Medico Chirurg-i- 
cal College of Philadelphia, 

and 
MAX GREENBAUM, D. D. S., Philadelphia. 

CHEHISTRY and METALLURGY.— By HENRY H. BOOM, 
M. D., Philadelphia, P-rotessor of Chemistry, 
Physics and Metallurgy in the Philadelphia 
Dental College. 

HISTOLOGY.— By ALBERT C. BUCKLEY, A. M., M. D., 
Philadelphia. Associate Professor of Histology 
in the Medico-Chirurgical College of Philadel- 
phia. 

ANATOMY.— By W. WALLACE FRITZ, M. D., D. D. S., 
Dean and Professor of Anatomy aud Clinical 
Surgery in the Medical Department of Temple 
College, Philadelphia ; Demonstrator of Anat- 
omy, Lecturer on Surgery and Chief Assistant 
to Medical Clinic in Philadelphia Dental College; 
Director of Philadelphia School of Anatomy, etc. 

PHYSIOLOGY.— By Wm. Harmar Good, A. B., M. D., 

Philadelphia, Demonstrator in Physiology at 

the Medico-Chirurgical College; Clinical Assist- 
ant in Medicine at the Samaritan Hospital, 
Philadelphia. 



CONTENTS. 



\ 



Page 

I OPERATIVE DENTISTRY i 

II PROSTHETIC DENTISTRY 45 

III ORAL SURGERY 73 

IV PATHOLOGY AND THERAPEUTICS 149 

V PATHOLOGY 168 

VI THERAPEUTICS AND MATERIA MEDICA 186 

VII CHEMISTRY AND METALLURGY 224 

VIII HISTOLOGY 260 

IX ANATOMY :. 290 

X PHYSIOLOGY AND HYGIENE 341 

XI SPECIAL DENTAL ANATOMY AND PHYSIOLOGY, 382 



OPERATIVE DENTISTRY. 

Describe method of cleansing the teeth. 

The oral cavities should first be washed with 
a 5% solution of hydrogen dioxide. Then with suit- 
able instruments all foreign substances should be 
removed from beneath the gum margin and upon 
roots. Then with a piece of orange wood, charged 
with pumice and an antiseptic, all the surfaces should 
be well rubbed, frequently rinsing the mouth with 
a suitable antiseptic. 

State the preferable material for fillings in cavi= 
ties beneath the gums. Give reasons for your choice. 

Gutta percha and amalgam. Gutta percha has 
made a notable record in these cases. It is non- 
irritating to the gum, does not necessarily require 
exclusion of moisture for its introduction and can 
be readily inserted. Amalgam, likewise, preserves 
teeth with such cavities, being easily introduced and 
not requiring absolute exclusion of moisture for its 
introduction. 

Give treatment of superior central incisors having 
small approximal cavities, when the teeth are in firm 
contact. 

The teeth are separated and gutta percha is 
used. Some operators claim that if the margins of 
these cavities be extended in accordance with the 
principle of " Extension for Prevention," they may 
be permanently filled with gold. 



2 OPERA TIVE DENTIS TR Y. 

Give the technic of preparing an approximal cavity 
and filling it with a combination of gold and tin. 

The cavity is given proper retentive form and 
may be filled one-third or one-half with tin, after 
which gold is added to completion. 

Describe the method of examining the teeth of 
patients and mention the instruments used. 

All the surfaces including sulci and grooves 
are carefully examined by means of fine explorers and 
mirrors Floss silk is passed between the teeth to detect 
a roughened surface. 

State under what condition a matrix is essential 
in filling cavities. 

In distal compound cavities of bicuspids and 
molars, especially when plastics are employed. 

Define abrasion of teeth and give the method of 
restoration. 

A mechanical wearing down of teeth brought 
about either through faulty occlusion, excessive wear 
or some habit like gritting of teeth. The exposed 
dentine is properly prepared for foundation and the 
margins so trimmed as to allow of the covering of 
the entire surface with a gold filling. 

Describe the treatment of anterior teeth that are 
sensitive at the gingival border. 

If there is no erosion of tooth structure, various 
antacid mouth washes are recommended. Milk of 
magnesia is very good. In cases of erosion the 
places are properly prepared and filled. 



OPERA T1VE . DENTISTR Y. j 

State the proper treatment of teeth rendered sore 
from wedging. 

If they are too sore to permit of any work being 
done, gutta purcha may be introduced in the space 
and the teeth allowed to rest for 24 or 48 hours. 

Describe the method of filling a cavity in a first 
permanent molar having a partly exposed pulp. 

The cavity is rendered antiseptic .b}/ the use 
of a non-irritating agent, after which oxysulphate 
of zinc under a metallic cap may be gently laid over 
the exposure. Zinc phosphate is next introduced 
and allowed to harden after which the cavity is rilled 
with gold or amalgam. Or the cavity ma}^ be tem- 
porarily filled with zinc phosphate to determine the 
success of the capping operation. 

In what respect is non=cohesive gold preferable to 
cohesive gold for filling teeth? 

It is more readily adapted to the walls of the 
cavity. 

What advantage has amalgam over gold for f ill= 
ing teeth? 

It is decidedly easier of introduction. 

How should an amalgam filling in a compound 
cavity involving the approximal and masticating surfaces 
of a molar be inserted ? 

The use of a matrix will aid in keeping the ap- 
proximal portion of the filling in place while it is 
being introduced from the masticating surface. If 
allowed to remain for several hours it will guard 
against the filling being displaced during mas- 
tication. 



4 OPERATIVE DENTISTRY. 

Give method of treating and filling a buccal cavity 
that extends beneath the alveolar border with adjacent soft 
tissues congested and bleeding. 

It may be necessary to introduce a temporary 
filling to press out and relieve the hyperemic con- 
dition of the gum, or rubber dam; then a clamp may 
be employed and the cavity filled at once. 

Give method of treating and filling a deep cavity 
when the tooth is sensitive, either to hot or cold. 

It is best to make an application of some seda- 
tive antiseptic and seal it in the cavity with tem- 
porary stopping for several days. When the normal 
condition of the pulp is restored, several layers of 
an impervious varnish should be interposed between 
the dentinal substance and the metallic filling. 

Give method of treating and filling a very sensi- 
tive superficial cavity with gold. 

The sensitivity should be reduced by some 
chemical agent like sulphuric acid in glycerine, 50%, 
after which the cavity is properly prepared and 
filled. Cataphoresis may also be resorted to. 

What are the comparative merits of hand and mal= 
let pressure? 

The hand pressure admits of more delicate deal- 
ing with the tooth structure and usually is not so 
severe in effect upon patients. The mallet enables 
us to work more quickly and usually results in bet- 
ter condensation of gold. 



OPERATIVE DENTISTRY. 5 

Give method of removing pulps that have not 
been devitalized. 

By desensitizing with hydrochlorate of cocaine, 
pressure anesthesia, or else under general anesthesia. 

Give the treatment in case of pulp exposure at= 
tended with pain in deciduous teeth. 

The employment of a pledget of cotton dipped 
in oil of Eucalyptus, oil of Cloves or Carbolic acid, 
until we effect its devitalization. 

How should deciduous teeth be treated and filled ? 

In such manner as will insure their retention for 
a proper time. Filled preferably with the plastic 
filling materials. 

Give method of treating and filling approximate 
cavities in permanent teeth of children when these teeth 
are deficient in lime salts. 

Perferably, with gutta percha until such time 
when, after proper systemic treatment, we can fill 
with gold. 

Describe the method of preparing and inserting 
an amalgam filling. 

The alloy and mercury are carefully weighed 
and may be used in equal parts. The mixing of the 
two in this proportion generally yields a thoroughly 
plastic mass. A portion of this is introduced into the 
cavity and well adapted against the parietes, after 
which the mercury may be expressed from the re- 
maining portion, and, by introducing it against that 
first introduced, it will draw up the mercury. This 
may be repeated until the mass is thoroughly har- 



6 OPERATIVE DENTISTRY. 

dened. The filling is polished at a subsequent 
sitting. 

State the advantages of amalgam over the other 
plastic fillings. Give reasons. 

It has a wider range of application and propor- 
tionately greater degree of durability. This is mainly 
due to its ability to withstand stress of mastication 
and insolubility in the oral fluids. 

State conditions under which amalgam should be 
used for filling. Give reasons. 

Wherever it is not exposed to view and where 
gold, for any reason, is not indicated. As amalgam 
fillings discolor, owing to formation or oxides and 
sulphides, the darkened appearance should not be 
exposed to view. 

What changes result after an amalgam filling is 
properly placed in a cavity ? 

Discoloration and the formation of a crevice 
along the margins which is more pronounced with 
some amalgams than with others. 

Describe method of treating and sterilizing a 
cavity for a filling, stating medicaments employed 

After the final preparation of the cavity, mois- 
ture must be excluded, after which pyrozone, satur- 
ated solution of thymol in glycerine, carbolic acid, 
or oil of cloves, may be employed. It must be borne 
in mind that antiseptics must be allowed to remain 
for some time in cavities to be decidedly beneficial. 

In what class of teeth should gutta percha, rather 
than metallic fillings, be used ? Give reasons. 



OPERATIVE DENTISTRY. . 7 

In teeth where the pulp is still in a vigorous 
degree of formative activity. Metallic fillings by 
inducing thermal shock might result in destruction 
of the pulp and leave the tooth improperly formed. 

Describe the insertion and finishing of a gutta 
percha filling. 

The material should be warmed over a suitable 
warmer and introduced piece by piece. In finishing 
the material warmed, instruments should be passed 
over the surface, always directing them towards the 
margins, not from them. Solvents should not be 
employed in finishing. 

State the benefit derived from the use of nitrate 
of silver in operative dentistry. 

In hypersensitive cavities in deciduous teeth 
where no filling material can be inserted, this agent 
has proven of value. As an obtundent of hypersen- 
sitive dentine upon exposed surfaces. As a disin- 
fectant. 

Describe the operation in which sulphuric acid may be 
used. 

To wash out carious bone. In certain forms of 
pyorrhea alveolaris as a solvent for concretions 
upon roots, and to open minute root canals to permit 
of easier entrance. 

Give the causes and general treatment of dental 
caries. 

Lactic fermentation. Complete removal of decay, 
thorough sterilization of cavity, proper preparation 
and filling. 



8 OPERATIVE DENTISTRY. 

What advantages has gold over other materials 
used for fillings ? 

Has excellent edge strength, does not alter its 
form after proper introduction, and is not affected by 
oral fluids. Preserves its color. 

What advantages has gutta percha as a filling 
material ? 

It admits of easy introduction. Conserves teeth 
permanently when properly used. Is non-irritant 
and non-conductive. 

What causes the deposit over an exposed pulp ? 

Any irritation which simply increases the func- 
tional activity of the pulp. Generally slight thermal 
shock. 

Is the deposit of secondary dentine physiologic or 
patholologic ? 

Physiologic, inasmuch as it is simply a revival 
of a normal function. 

Give treatment in case of alveolar abscess with 
fistula, acute and chronic. 

In the acute form, the opening is enlarged so 
that the seat of infection can be reached. It is 
washed out with hydrogen dioxide and packed with 
borated or sterilized gauze. The tooth is opened and 
pulp canals thoroughly antisepticized. 

In the chronic, after exhausting thorough anti- 
septic measures both through fistula and root canals, 
amputation of affected root has been recommended. 
Give treatment in case of pulpitis. 

If our various mild and powerful sedatives are 



OPERATIVE DENTISTRY* 9 

unavailing, we may, under cataphoresis, force cocaine 
into the dentinal structure and expose the pulp; and, by 
inducing hemorrhage, produce relief ; after which it 
is devitalized. 

What is erosion ? Give its cause and treatment. 

A chemical disintegration of hard dentinal 
structure generally occuring upon the labial surfaces 
of the superior teeth. It is caused by the elimina- 
tion in all probability of acid sodium phosphate by 
the labial glands in consequence of a gouty or rheu- 
matic diathesis. If the destructive effect is suffi- 
ciently marked, these places must be filled. Antacids 
should be recommended in the mouth, and the 
patient be referred to the general practitioner for a 
thorough anti-gout or rheumatic regime. 

Give the etiology and the general preventive 
treatment of dental caries. 

Lactic fermentation. Proper cleansing of the 
oral cavity by removing all particles from the sur- 
faces of teeth by means of tooth brushes and pow- 
der, floss silk, and the use of proper antiseptics. 

How is dental caries classified ? 

Superficial, simple, deep-seated and complicated, 
involving exposure of the pulp. 

What is superficial dental caries ? Give treat- 
ment. 

That stage of decay which has not penetrated 
the enamel. Remove it by discs and stones and 
thoroughly polish the surface. 



io OPERATIVE DENTISTRY* 

What is deep=seated dental caries ? Give treat= 
ment. 

That stage of decay which would render likely 
irritation of the pulp through conductivity of thermal 
deviations. Remove all decay, properly sterilize, ap- 
ply several layers of varnish after cavity is formed, 
and properly fill. 

What is the best treatment to render a cavity 
antiseptic ? 

After removal of all decay and irrigating with 
hydrogen dioxide, it is best to seal in the cavity, 
for several days, a penetrating antiseptic like thymol 
in alcohol, glycerine or oil of cloves. 

Why does the application of nitrate of silver 
arrest decay of teeth ? 

It forms with the detinal substance an im- 
penetrable albuminate of silver which has high anti- 
septic property. 

Mow should a first permanent molar with inflamed 
pulp be treated in a child seven years of age ? 

If, after careful study of the articulation of the 
two jaws, it does not appear likely that its removal 
will interfere with normal occlusion, the tooth, if 
seriously affected, may be extracted. The second 
molar very likely will erupt in its place. It does 
not, however, appear probable that in a child seven 
years of age the first molar will have an inflamed 
pulp. 

Give the method of removing pulp and filling 
root canals in inferior molars with approximal cavities in 
distal surface. 



OPERATIVE DENTISTRY. n 

Sufficient tooth structure must be removed in 
order to have easy access to the canals. If various 
instruments at our command for extirpating the pulp 
are not adequate for the requirements, we may de- 
stroy remaining pulp filaments by pumping 50% 
sulphuric acid into canals and neutralizing with 
sodium bicarbonate. The canals are permanently 
filled with gutta percha, oxychloride of zinc or mum- 
mifying paste. 

At what age is it best to extract the first perma= 
nent molar ? Give reasons. 

If we find at any time before eruption of second 
permanent molar that the first is so seriously im- 
paired that there is no likelihood of its useful re- 
tention for any considerable time; and, if its removal 
will not bring about interference with the remaining 
normal occlusion, then it may be extracted to allow 
the second molar to erupt in its place. 

What is dental caries ? 

A chemical disintegration of tooth structure com- 
bined with a liquefaction of the remaining organic 
dentinal matrix through lactic fermentation and bac- 
teria that, by their excretions, have the property of 
dissolving organic substances. 

Describe the treatment of a tooth that is ex= 
tremely sensitive to thermal changes after filling. 

A gutta percha cap may be adjusted over the 
tooth and counter-irritants applied directly over the 
root of the tooth. If this is not sufficient to relieve 
the pulp hyperemia, the filling should be removed 



12 OPERATIVE DENTISTRY* 

and sedatives applied in the cavity and filled tem- 
porarily until the pulp returns to normal condition. 

Give method of extracting a tooth with root so 
enlarged by exostosis that its removal through the socket 
must result in fracture. 

The gum tissue is raised and sufficient bony 
structure is drilled away to free the root. 

Give method of treating fissures in children's 
teeth before they are attacked by caries. 

They may be treated by applications of silver 
nitrate. 

When the walls of cavities have softened beneath 
approximal gold fillings extending beneath the gums, how 
should these cavities be treated and filled ? 

Remove affected tooth structure, apply antisep- 
tics and fill either with amalgam or gutta percha. 

Under what conditions is immediate root filling 
advisable ? 

When the pulp is devitalized and completely 
extirpated and there is no evidence of hemorrhage 
from the apical vessels. 

What anatomic changes are produced by the loss 
of the teeth ? 

Resorption of alveolar walls and consequent 
falling in of lip and cheek. The fullness of the 
region of the superior cuspids is lost and becomes 
very evident by a changed expression. The lower 
jaw comes forward. 

State the injuries that may result from wedging 
teeth. 



OPERATIVE DENTISTRY. i 3 

Pericementitis and possible devitalization of 
pulp. 

What are the risks attending the devitalization of 
pulps by arsenic ? 

Leakage and consequent destruction of adjoining 
tissues. 

Give the most practical method of removing pulps 
from bicuspids and molars. 

Some of the canals in these teeth are often 
attenuated, making it difficult for the entrance of 
suitable instruments. After removing all possible 
with the finest broaches, mummifying paste may be 
applied without likelihood of any future trouble. 

Under what conditions in deciduous dentition is 
the lancing of the gums indicated ? Explain. 

In pathological dentition indicated by marked 
irritability and fretfulness of the child and hyperemic 
condition of gum tissue. Lancing relieves the resis- 
tance which the gum offers to the erupting tooth and 
allays the pathological features. 

Give a general rule for the preparation and forma= 
tion of cavities before filling, and name the points that 
require special care in excavating. 

Remove weak overhanging walls, and decay, and 
properly sterilize ; care must be exercised not to ex- 
pose the pulp unless decay has penetrated into its 
substance. The margin must be properly bevelled 
along the line of enamel cleavage and the cavities 
given retentive form. 



14 OPERA TIVE DENTISTR Y. 

What are the diagnostic signs of a dead pulp in a 
tooth ? 

The development of acute septic pericementitis 
followed by acute alveolar dental abscess and the decid- 
ed clouding of the tooth. The latter generally being 
apparent before the existence of the former. 

Mention the class of operation in which a combi= 
nation of gold and amalgam is preferable to either material 
used separately. Explain. 

In approximal cavities extending well up under 
the gum tissue. Amalgam alone is too unsightly. 
Gold is very difficult to introduce under the gum. 
The amalgam is first introduced, and, after it has set, 
the rubber, is adjusted, the cavity being finished in. 
gold. 

In what respect is amalgam preferable to other 
plastic filling materials ? 

It has the quality of withstanding attrition and 
is practically insoluble in the fluids of the mouth. 

Why are the risks especially great in rapid wedg= 
ing of the superior central incisors ? 

There may be a separation of the superior maxillae 
and failure of the incisors to return to their normal 
position. The pulps may also become devitalized. 

What characteristic pain results from pathologic 
conditions of the pericemental membrane ? 

Pain upon pressure or tapping of tooth. 

What are the distinguishing symptoms of peri= 
cemental and pulp pain ? 

Pericemental pains are increased when pressure 



OPERATIVE DENTISTRY. i 5 

is brought to bear upon the tooth. Pulp pain res- 
ponds to thermal variations. 

How should pathologic disturbance of the peri= 
cemental membrane be treated ? 

Removing the cause, giving rest to the tooth, 
applying counter-irritants at some distance. Seda- 
tives like tincture of Aconite may be applied directly 
over the affected tooth. 

How should pain resulting from pathologic condi= 
tions of the pulp be treated ? 

If the lesion is not severe, the cause of the pain 
is removed and guarded against ; sedatives are em- 
ployed in the cavity. If the condition is beyond con- 
servative treatment, then the pain is subdued and an 
arsenical application is made to devitalize. 

What classes of operation tend to induce patho= 
logic conditions of the pulp and membranes of the teeth ? 

Large gold fillings, for which considerable space 
must be prepared by extensive wedging and long 
continued malleting, may induce pericemental dis- 
turbances. Also, correcting irregularities, this may 
lead to pathological conditions of both pericementum 
and pulp. Excessive reduction of the enamel for 
crown and bridge work may further lead to pulp dis- 
turbances. 

What special precaution should be observed in in= 
serting gold fillings in approximal cavities of the teeth ? 

When the filling is completed it should properly 
restore the surface or shape of the tooth as well as 
touch the adjoining tooth ; the margins of the cavity 



j 6 OPERATIVE DENTISTRY. 

should be made self-cleansing in accordance with the 
principle " extension for prevention." 

They should also be made as inconspicuous as 
possible. 

What are the characteristic symptoms of neuralgia 
arising from a crowded denture ? 

Reflex pain generally felt in the ear and down 
the neck. 

What are pulp stones? Give treatment. 

Calcific formations generally within the body of 

the pulp. The treatment is devitalization and re- 
moval. 

How should a cavity be treated and filled when 
the dentine is highly inflamed ? 

A sedative should be placed in the cavity covered 
by a temporary filling. 

Describe in detail the method of restoring, with 
a combination of amalgam and cement, frail, broken 
crowns. 

Zinc phosphate is mixed thin and adapted in 
position, being careful to remove it from such places 
as would, after completion of the operation, expose it 
to the fluids of the mouth. Previously prepared 
amalgam is then worked into the setting zinc phos- 
phate in such a manner as will insure its retention. 
The filling is then properly contoured and finished. 

State the most efficient and satisfactory treat= 
ment of teeth that have become sensitive with tendency 
to decay under plate clasps. 



OPERATIVE DENTISTRY. i 7 

Apply silver nitrate, caustic potash or zinc chlo- 
ride. It may also be necessary to cut out affected 
portion and fill with gutta percha. 

Give pathology and treatment of green stain on 
children's teeth, mentioning the medicament used. 

The remains of the enamel cuticle is invaded by 
bacteria, and in their development produce a green 
coloring material, staining the surface of the tooth. 
Teeth should be thoroughly polished, removing the 
remnants of Nasmyth's membrane, also, the slightly 
roughened surface beneath. Peroxide of hydrogen 
or tincture of iodine in combination with pumice, will 
be found useful as aids to remove discoloration. 

Why do pulpless teeth loose their natural hue? 
Give a remedy for preventing this change. 

It is due to disorganization of the red blood cor- 
puscles and their absorption into the dental tubuli, 
following the death of the pulp. Also the formation 
of various substances that act as discoloring agents. 
The sulphide of iron may be formed which produces 
the yellow discoloration. If after devitalization, the tooth 
is treated with a 25% solution of pyrozone, and a lin- 
ing of white oxyphosphate of zinc is introduced, 
much may be done to keep the color of the tooth. 

Differentiate pyorrhea alveolaris and salivary 
calculus. Give the cause, prognosis, and treatment of 
each. 

Pyorrhea alveolaris means a flow of pus from the 
socket of the tooth, but the disease itself embraces 
certain other characteristic features. There is necro- 



j 8 OPERATIVE DENTISTRY. 

sis of alveolar walls and pericementum and a pro- 
gressive loosening of the tooth. Salivary calculus 
merely signifies an accumulation of calculus coining 
from the salivary fluids and deposited around the 
cervical margins of the teeth. It may lead to a form of 
pyorrhea by irritating the gum tissue and making 
the site of its location favorable for septic formations, 
in connection with which we would find pus forma- 
tion, necrosis of alveolar walls and pericementum and 
a gradual loosening of the tooth. The prognosis 
is favorable. The treatment consists in removing all 
deposits, inducing antisepsis ; if the teeth are con- 
siderably loosened, they may be held quite firmly by 
means of bands. In the other forms of pyorrhea, the 
prognosis is not favorable. Generally there is a sys- 
temic complication which should receive adequate 
attention. Locally, the treatment is practically the 
same as in the first grade. 

Give directions for the general care of the mouth 
and teeth of children. 

Directions should be given for the proper use of 
the brush, and a suitable tooth powder. The teeth 
should be bathed, at least in the morning and before 
going to bed, with a suitable antiseptic wash. And,, 
furthermore, frequent examinations should be ad- 
vised. At these examinations, which may be con- 
ducted monthly, the surfaces of the teeth should be 
thoroughly polished. 

How should crooked buccal root canals be treated 
and filled ? 

50% sulphuric acid should be utilized to effect 
as thorough an opening of the canal and removal of 



OPERATIVE DENTISTRY. i 9 

pulp as is possible. If this means does not allow of 
reaching apical ends, then a mummifying paste may 
be introduced. 

When should a pulp be devitalized and when 
capped, and why ? 

The dental pulp should be devitalized when it 
becomes the seat of such circulatory changes as 
ultimately would lead to its death, indicated by con- 
tinued paroxysmal pain markedly aggravated by 
applications of heat. If left alone, it would die and 
subsequently become the centre of septic processes, 
causing acute septic pericementitis and alveolar den- 
tal abscess. 

The dental pulp should be capped when we 
find an exposure without evidence of serious compli- 
cations, such as would make clear the necessity for 
devitalization. Furthermore, the pulp should be 
capped if in the preparation of the cavity it is acci- 
dentally exposed. This conservative treatment is 
favored because it insures translucency to the tooth, 
vitality to the dentine, and a general immunity to 
septic complications. 

How would you prepare and fill proximal cavities 
with frail wall to the cutting edge in the anterior teeth ? 

Frail walls that will not admit of proper adapta- 
tion of gold should be removed until strong tooth 
substance is reached. In this a proper anchorage can 
then be made and the tooth filled. 

How would you relieve excessive sensibility of the 
dentine? 



20 OPERATIVE DENTISTRY, 

Hypersensitive dentine is treated by two general 
classes of remedies, anodynes and caustics. In the 
first group we have the essential oils, campho-phe- 
nique, and various alkaloidal preparations ; in the 
second, carbolic acid, chloride of zinc, caustic potash,, 
nitrate of silver and equal parts of sulphuric acid 
and glycerine. The anodynes are employed when 
nearness to the pulp precludes the use of caustic ap- 
plications. In very obstinate cases hydrochlorate of 
cocaine may be driven into the dentinal structure 
under the electric current. General anesthetics may 
also be utilized in very stubborn conditions. It is 
also well to bear in mind that sharp instruments 
modify these painful impressions. 

When are artificial crowns and bridges indicated 
and when not ? 

When in the anterior part of the mouth a tooth 
becomes objectionably discolored and cannot be res- 
tored in color through the various bleaching pro- 
cesses. In the posterior portion when a tooth is so 
far gone as to preclude useful restoration by filling 
materials. Bridges are indicated when one or more 
teeth have been lost and we are able to utilize firm 
roots or crowns at each end of the space for support. 
Under no circumstance should bridges be adjusted 
when the abutments do not meet this indication. 

What effect does salivary calculus have upon the 
teeth and gums ? 

Its accumulation causes resorption of alveolar 
walls and consequent loosening of teeth. It induces 
hyperemia of pericementum and gum tissues, as well 



OPERATIVE DENTISTRY. 21 

as necrotic changes, by favoring retention of septic 
material. 

What diseases may arise from a putrescent pulp? 
How should such teeth be treated to restore them to use= 
fulness ? 

Acute septic pericementitis followed by acute 
alveolar dental abscess. In acute pericementitis an 
opening is made leading to the putrescent pulp for 
the escape of the various products formed in the 
putrefactive process. This, together with the seda- 
tive effect of an application of the tincture of aconite 
to the gum tissue, and the counter irritating effect of 
tincture of iodine applied some distance from the 
affected area, and the use of antiseptic astringent 
mouth washes, usually afford relief. After this, ef- 
forts are made to thoroughly cleanse and sterilize the 
root canal or canals. Peroxide of sodium, peroxide 
of hydrogen, or formalin, in varying strengths, are 
carefully introduced. When no odor can be detected 
it is well to introduce a temporary cotton dressing, 
the non absorbent variety, carrying upon its surface 
campho-phenique, or a saturated solution of thymol 
in glycerine. After a few weeks a permanent canal 
filling of gutta percha, oxychloride of zinc, or some 
antiseptic paste may be employed. If we are dealing 
with an acute alveolar abscess, which is usually diag- 
nosed in the early stages by the existence of a throb- 
bing pain, then the first indication is to rid the part 
of the pus. This is accomplished by making an in- 
cision through the gum tissue and with the engine 
burring through the alveolar wall until an outlet for 



22 OPERATIVE DENTISTRY. 

pus is secured. Or we may adopt the slower method 
of overstimulating the gum tissue by the use of the 
pepper bag, and thus by reducing its resistive force 
invite a passage for the pus. After the outlet for the 
pus is secured, then all the preceding antiseptic mea- 
sures indicated in the treatment of acute septic peri- 
cementitis are rigidly followed. 

Describe your method of preparing and filling 
approximate cavities in bicuspids and molars. 

The first essential indication is to secure suffi- 
cient space through separation. In simple cavities 
the margins had better be extended in accordance 
with the principle — " extension for prevention." In 
compound cavities the use of the matrix frequently 
abridges an otherwise protracted filling operation. 
Furthermore, the general principles applicable to all 
cavities must ever be present in the mind of the 
operator. These are thorough removal of decay, 

sterilization of cavity, proper formation as to reten- 
tive as well as marginal requirements. 

What are the principal causes of irregularities in 
teeth ? Name two typical cases and describe your treat= 
ment. 

The causes of irregularities are hereditary and 
acquired. Chief among the acquired causes is early 
loss of deciduous teeth, also such habits as thumb 
sucking and lip sucking. We may have, as a result 
of too early loss of deciduous teeth, the permanent 
cuspids standing outside of the arch. As the result 
of thumb sucking, the superior incisor teeth may 



OPERATIVE DENTISTRY. 23 

stand outside of their normal line and the lower ones 
inside. In case of the irregular cuspids the removal 
of the first bicuspid very frequently is sufficient to 
cause the cuspid to assume its normal place. Or by 
adjusting a Magill band upon the first or second 
molar with a tube soldered to it, and a like appli- 
ance for the lateral incisor. A bar connecting these 
teeth with a pin soldered about half way and then 
securing attachment to the cuspid and adjusting a 
rubber band, this tooth readily comes into its normal 
place. In case of the outstanding incisors the Ma- 
gill band is made for each lateral with an exten- 
sion over the central. A vulcanite plate is next 
made for the roof of the mouth with the portion 
appoximating the lingual surfaces of the incisor 
teeth cut away to allow for their posterior movement. 
In the center of the plate a good hook is fastened 
and then by means of rubber bands these teeth are 
drawn backwards. 

Decribe the difference between cohesive and non= 
cohesive gold, and state when indicated separately or in 
combination. 

Cohesive gold is so prepared as to permit of the 
thorough welding of one piece to another. Non- 
cohesive gold does not admit of this, because some 
foreign substance is deposited upon its surface. 
Non-cohesive gold is used when we have all the 
walls of the cavity standing and they are strong en- 
ough to resist the force of the wedge principle adopted 
in its condensation. It may also be employed as a 
foundation in a filling to be completed with cohesive 
gold. 



24. OPERATIVE DENTISTRY. 

How should cervical cavities be prepared with 
reference to the gum margin ? 

It is well to extend the margin of cervical cavi- 
ties beneath the border of the gum. In this way 

they are better protected from decay. 

When and how should a pulp be devitalized ? 

A paste of arsenious oxide, hyrochlorate of co- 
caine and an essential oil is generally employed to 
devitalize the pulp. 

Give method of treating a pulp canal containing 
putrescent pulp. 

Putrescent pulp is best treated by applications 
of peroxide of sodium or formalin (10%) followed by 
temporary dressings of thymol in glycerine until 
the canal is completely sterile. 

State methods of filling pulp canals. 

The materials most generally used are chlora- 

percha followed by warm gutta percha cones, or 

oxychloride of zinc mixed in and introduced upon 

threads of aseptic cotton or aristol and wax. 

State the best methods of applying gold to the 
walls of cavities in poorly calcified teeth. 

Dr. Black's experiments have quite conclusively 
shown that there is no such condition as a poorly calci- 
fied tooth. The difference in the percentage of lime salts 
of over a thousand teeth was practically the same. 
But some teeth appear to be poorly organized. In 
such teeth the dentinal substance is cut most readily 
and when gold is used, It is better adapted if we first 
use a lining of oxychloride or oxyphosphate of zinc. 
Sometimes, non-cohesive foil is first used followed 
by cohesive gold. 



OPERATIVE DENTISTRY. 25 

How should a freshly exposed pulp be treated ? 

After carefully sterilizing the cavity with hydro- 
gen peroxide a paste of zinc oxide and oil of cloves 
is prepared ; this is gently applied over the exposure, 
after which several layers of an impervious varnish 
are used. Zinc phosphate may next be flowed over 
this, taking great care not to exercise any pressure. 
The cavity is then filled according to indications. 

What advantages are claimed for a combination 
of gold and tin as a filling material ? 

Tin foil is more readily adapted than cohesive 
foil and furthermore, it markedly reduces the con- 
ductivity of the filling. 

What causes pericementitis ? Give treatment. 

Pericementitis is most frequently caused by the 
entrance of septic matter from the pulp canal into 
the tissues of the apical space. The treatment con- 
sists of opening the pulp canal, removing the con- 
tents and destroying all septic matter by the use of 
such agents as sodium dioxide, hydrogen dioxide, 
formalin or thymol in glycerine. Powerful counter- 
irritation to the gum with tincture of iodine, sedation 
by means of tincture of aconite and surgical rest to 
the affected tooth. 

Under what conditions of the dentine is a plastic 
filling preferable to gold ? 

Excessively hypersensitive dentine may be bet- 
ter filled with a plastic filling. 

How should a pulp be devitalized by arsenic when 
decay exists below the soft tissues ? 



26 OPERATIVE DENTISTRY. 

By pressing out soft tissues and filling that por- 
tion of the cavity with temporary stopping, after 
which arsenic may be applied without danger to the 
soft tissues. 

Give diagnosis of irritation from pulp stones. 

Continued acute paroxysmal pains without re- 
lief from strongest sedative applications. 

Give method of extracting the roots of an inferior 
third molar when the crown is broken off and the gums 
swollen. 

An incision may be made buccally and lingually 
through the gum tissue and dissected from the 
underlying structure. In this way we may extend 
the forceps down some distance and get a firm hold ; 
then by an upward and backward movement, we can 
dislodge the roots, or use an elevator. 

What are the best materials for filling decidu- 
ous teeth ? 

The plastic filling materials. 

Describe the method of treating decay in decidu- 
ous teeth. 

Remove as much of the decay as would be con- 
sistent without encroaching upon the pulp, then 
wash with peroxide of hydrogen or touch with silver 
nitrate. Finally fill with a plastic filling. 

Give the treatment of exposed pulp in deciduous 
teeth of a child six years of age. 

As it is important to conserve the pulp as a 
means of maintaining aseptic conditions in the canal 
and thus favoring resorption of the deciduous roots, 



/ 

OPERATIVE DENTISTRY. 2? 

it is best to first take all antiseptic precautions and 
then cover the exposure with a paste of zinc oxide 
and oil of cloves, after which zinc phosphate may be 
flowed in the cavity. 

Describe method of bleaching a central incisor. 

2 5% pyrozone may be used with or without the 
cataphoric current, or what seems to be in favor with 
many practitioners is sealing the apical foramen and 
inserting chlorinated lime and a solution of either 
acetic or oxalic acid and allowing this to remain in 
the cavity about twenty-four hours. Close up care- 
fully with zinc phosphate. 

Give method of restoring the edges of incisors that 
are worn away by friction. 

Preparing a foundation in the dentine and bevel- 
ing outwardly the enamel margins so that gold pro- 
tects the entire incisal surface. 

How should cavities be prepared and filled, involv- 
ing approximal and occlusal surfaces ? 

All weakened overhanging walls of enamel 
should be trimmed away, and the margins of the 
cavity extended to a point where they can be easily 
reached in cleansing. No grooves should be made 
in the approximal part of the cavity, as they would 
weaken the walls. The occlusal portion should be 
made retentive in form — dovetailing rather than 
grooving. At the gum margin, the floor of the cavity 
should be flattened to make a firm ledge for the fill- 
ing to rest upon. Such cavities, if deep, should be 
varnished and lined with oxyphosphate of zinc before 
inserting a metallic filling. 



28 OPERATIVE DENTISTRY- 

Describe carefully the condition requiring the de= 
vitalization of the dental pulp. The method you pursue 
and precautions necessary. 

A pulp which has been exposed by caries should 

be devitalized with arsenic, which is applied in a 

minute quantity in combination with such sedative 

agents as acetate of morphine, or muriate of cocaine y 

made into a paste with one of the essential oils. 

Great care should be taken to hermetically seal this 

preparation in the cavity, to prevent its coming in 

contact with the gum tissue, pericementum or alveolar 

process. When it is possible to do so, rubber darn 

should always be applied before the application is 

made. 

Give the etiology and treatment of an apical alvec- 
lar=dental abscess. 

The etiology or cause of an apical alveolar-dental 
abscess is the invasion of pyogenic organisms into the 
already inflamed apical space, gaining access either 
through a carious cavity, or through the circulation. 
The treatment is first, the removal of the contents of 
the pulp cavity and canals and the cleansing of the 
abscess cavity, which should be washed with x% 
pyrozone. The canals of the tooth should be thor- 
oughly sterilized with sodium dioxide, followed by 
10% sulphuric acid. A temporary dressing of thymol 
and menthol should then be placed in the canals, and 
the tooth given surgical rest. If, in the course of a 
few days, tenderness disappears and there is an ab- 
sence of pus, and the dressing removed from the tooth 
emits no purulent odor, the canals may be perma- 
nently rilled. 



OPERATIVE DENTISTRY. 2 9 

How would you treat deciduous teeth with exposed 
pulps ? 

If the exposure of the pulp of a deciduous tooth 
be small, and the pulp not giving evidence of ex- 
treme pathological disorder, the pulp may be 
capped and an attempt made to preserve its vitality 
in order that root resorption may not be interfered 
with. If, on the other hand, the exposure of the pulp 
be large and accompanied by marked pulp disorder, 
the pulp should be destroyed with iodine, and the 
canals filled with paraffine and aristol. 

How would you diagnose a diseased or dead pulp 
in an apparently sound tooth ? 

Diseased pulps may be diagnosed by their altered 
response to the thermal test. Dead pulps do not 
respond at all to these tests. 

In doubtful cases, how would you distinguish a 
temporary one from a permanent tooth ? 

An examination of the enamel edge at the neck 
of the tooth will show a thickened ridge, if the tooth 
be a temporary one. If permanent the enamel will 
bevel off to a feather edge. 

How would you prepare and fill approximal cavity 
with frail walls extending to the cutting edge of an 
incisor? 

All frail margins of enamel should be trimmed 
away. The labial margin of the cavity should be 
brought to the cutting edge in a direct line. The 
cervical aspect of the cavity should be prepared as a 
flat ledge, whose base is at right angles with the 



jo OPERATIVE DENTISTRY. 

longitudinal axis of the tooth. The lingual margin 
should follow the direction of the labial to within 
about 1-16 of an inch of the cutting edge, where it 
should turn at right angles, and pass across the tooth 
at the cutting edge to a point a little beyond the 
depth of the cavity. The lingual layer of the enamel 
only is removed. A slight groove is- cut in the inci- 
sal portion, and a pit sunk at its extremity. The 
labial plate of enamel should be beveled from within 
outward, and likewise, all of the other margins ex- 
cept cervical, which should remain as before stated — 
flat and at right angles to the longitudinal axis of the 
tooth. A starting point, if gold is to be used, may 
be made in this surface of the cavity. If caries has 
not advanced too for, the cavity may be prepared in 
the form of a dovetail at the cervical end. The fill- 
ing may now be started at this part of the cavity with 
non-cohesive or cohesive gold, and built squarely to a 
point where the greatest fullness of contour will be 
made. The progress of the filling should then be 
towards the groove and pit in the cutting edge, and a 
sufficient bulk of gold laid on, to give strength to re- 
sist necessary malleting on the cutting edge. The 
filling may now be finished without fear of dislodging 
by malleting. By this method of preparation, the 
filling material has a broad flat substantial base upon 
which to rest, and resists lateral stress by virtue of 
the pit and groove on the occlusal edge. 

Is lancing the gums indicated in dentition ; if so, 
under what condition ? 

Lancing the gum is indicated in dentition when 



OPERATIVE DENTISTRY. ji 

there is an extreme inflammatory condition of the 
gnm over the tooth about to erupt, which is the cause 
of sufficient discomfort to impair the health of the 
child. 

Describe the process of replanting teeth and pre- 
cautions necessary ? 

Replanting a tooth, (the return of a tooth to the 
socket from which it was extracted) must be con- 
ducted with extreme antiseptic precaution. The 
tooth should be first carefully extracted, the beaks 
of the forceps being guarded by small pieces of spunk. 
The tooth should be placed in a warm antiseptic solu- 
tion, r to 2000 bichloride of mercury. If this method 
is employed for the cure of alveolar abscess, the 
alveolus should be thoroughly cleansed with warm 
antiseptic spray, and any portion of the sac which 
may have been retained, removed. The portion of 
the root which has been denuded of pericementum 
should be cut away, and the surface polished. Great 
care should be observed not to injure the remaining 
normal pericementum. The tooth may now be re- 
placed in its socket, and firmly held for a few days by 
ligatures, and a bolus of oxyphosphate of zinc 
cement. During the entire process of replantation, 
the mouth should, from time to time be carefully 
sprayed with such antiseptic preparations as phenol 
sodique, listerine, etc. 

Describe the method of treatment in painful pulp 
exposure. 

The cavity should be thoroughly washed with 
warm antiseptic solutions, and such excavating done 



32 OPERATIVE DENTISTRY. 

as will 'give the cavity a retentive form. A paste of 
muriate of cocaine and Ceylon oil of cinnamon is 
then placed over the pulp, protected by a pellet of 
cotton. Over this should be flowed enough thinly 
mixed oxy phosphate of zinc to cover the cotton. 
When the cement has set, the balance of the cavity 
may be filled with temporary stopping. If after 
twenty. four or forty-eight hours, the pulp exhibits no 
marked hyperesthesia, an application of arsenic should 
be made and the pulp destroyed. 

Describe the diagnostic signs of dead pulp in a 
tooth, when there is no pulp exposure. 

Dead pulp may be diagnosed, when there is no 
pulp exposure, by lack of response to the cold pro- 
duced by ethyl chloride spray ; also by the electric 
mouth mirror, demonstrating a marked opacity of the 
tooth. 

Describe the operation of implanting, and the pre= 
cautions necessary. 

The operation of implantation consists in pre- 
paring an artificial cavity in the gum tissue and max- 
illary bone, where a natural tooth, carefully selected 
as to size and shade, is to be inserted and firmly held 
until nature has deposited a calcific matrix around it. 
The precautions necessary are thorough asepsis, not 
only of the tooth to be implanted and of the artificial 
socket, but also of the entire oral cavity, and instru- 
ments used in the operation. 

Name the probable cause of erosion of the teeth, 
and give the treatment. 

The probable cause of erosion of the teeth is an 
abnormal acid secretion by the glands in the inner 



OPERATIVE DENTISTRY. jj 

surface of the lips, destroying the tooth substance. 
The progress may be arrested by the milk of mag- 
nesia as a mouth wash before retiring. The cav- 
ities occasioned by erosion should be rilled with 
gold or gutta percha. 

When is protection to the denal pulp from thermal 
changes indicated, and how is it accomplished ? 

Protection to the dental pulp from thermal 
changes is indicated when that organ responds in an 
exaggerated degree to the application of heat or cold. 

In the treatment of teeth containing cavities, the 
cavities should be varnished, and lined with cement 
before metallic fillings are inserted. In a tooth not 
containing a cavity, the adjoining teeth should be 
wedged from it, a cap of gutta-percha placed over it, 
and allowed to remain until the pulp regains a nor- 
mal condition. 

Describe method of securely anchoring a gold fill= 
ing in a distal cavity with frail palatal walls, in a vital 
superior cuspid. 

Anchorage may be secured by removing a nar- 
row parallel strip of the labial plate of enamel at the 
occlusal edge, not disturbing the labial wall. Groove 
the dentine along this excavation and sink a pit at 
its mesial extremity A groove should also be made 
at the cervical end of the cavity. This anchorage 
will resist all stress applied anteriorly. 

How may an inflamed living pulp be diagnosed 
and located when no cavity exists ? 

The rubber dam should be applied and the tooth 
exposed to applications of both heat and cold. The 



34- OPERATIVE DENTISTRY, 

pulp will respond with a paroxysm of severe pain to 
the heat, with less severity to the cold. In these 
cases where no cavities exist, the pericementum is 
usually affected, and responds to percussion. The 
history is usually as follows : The tooth has been 
subjected to traumatic injury, and later became 
slightly sensitive to touch ; still later vague pains in 
the pulp appeared, gradually increasing in severity. 

Describe the treatment of excessive hemorrhage 
following tooth extraction. 

Excessive hemorrhage after extraction may be 
suppressed very successfully by the following 
method : A roll of cotton dipped in sandarac varnish 
and thickly powdered with tannic acid is packed 
firmly into the alveolus, and allowed to remain for a 
week or ten days. If, upon withdrawing the cotton 
plug, hemorrhage is resumed^ the alveolus should be 
thoroughly cauterized with a thermo-cautery, and a 
second plug inserted. Fluid extract of ergot may be 
prescribed internally in drachm doses. 

How would you decide whether to cap or devitalize 
a partially or completely expos d pulp ? 

If a pulp is partially exposed by caries after 
thorough antiseptic precautions have been taken and 
the pulp rendered normal, it should be capped, tem- 
porarily filled, and carefully watched for six months 
or a year. If it remains normal for that time, the 
cavity may be permanently filled. Pulps com- 
pletely exposed by accident while excavating, which 
do not come in contact with the fluids of the mouth y 
may be successfully capped. Pulps completely ex- 



OPERA TIVE DENTIS TR Y. j 5 

posed by caries should be invariably devitalized. 

Describe minutely your treatment and manner of 
capping a pulp. 

With the rubber dam applied, the cavity should 
be thoroughly cleansed and rendered aseptic by the 
use of a thymol solution. The cavity should then 
be thoroughly dried, and a small concavo-convex 
piece of copper, gold, lead, or platinum rilled with a 
mixture of zinc oxide and oil of cinnamon placed 
over the exposure, and sealed with zinc oxysulphate 
cement. This should be again covered with oxy- 
phosphate of zinc, the cavity being first varnished 
w r ith a solution of amber in chloroform. Fill the 
cavity temporarily, and if, in six months, the condi- 
tions are favorable, a permanent filling may be in- 
serted. 

Describe your method of treatment and manipula- 
tion in devitalization and extirpation of the pulp, and fill= 
ing the canal. 

Apply rubber dam, and remove as much of the 
carious contents of the cavity as the patient will per- 
mit. A small exposure should be made, and a minute 
particle of arsenic in combination with cocaine muri- 
ate and oil of cinnamon applied to the exposed sur- 
face. Protect the application with a soft pellet of cot- 
ton, and seal with temporary stopping or thinly 
mixed oxyphosphate of zinc cement. In forty-eight 
hours, if the pulp shows no signs of vitality, again 
apply the rubber dam, remove temporary filling, and 
with thoroughly clean burs, expose the whole of the 
pulp chamber. The body of the pulp is now re- 



j6 OPERATIVE DENTISTRY. 

moved, and with, barbed pulp extractors, extirpation of 
the root portion is accomplished. The canal or canals 
should be washed with sodium dioxide solution, fol- 
lowed by aromatic sulphuric acid, and then dried with 
alcohol and warm air. A few shreds of cotton wound 
upon a broach and dipped in chloro-percha solution , 
should be carried into the canals. Repeat this sev- 
eral times until the chlora-percha has been pumped 
to the apex of the canals. Cones of solid gutta-percha 
are then inserted in the canals, and the tooth tem- 
porarily filled. If in forty-eight hours no pericemen- 
tal disorder is manifest, a permanent filling may be 
inserted. 

Describe under what conditions you would place 
crowns upon natural roots, and your method of procedure. 

Crowns are indicated when the natural crown of 
the tooth has been so far destroyed as to prevent its 
restoration by filling. If some portion of the natural 
crown remains, and the tooth is situated posterior to 
the cuspid, the crown may be partially restored with 
amalgam, and a hollow metal crown attached. Or, 
if the pulp be not vital, and the tooth be anterior to 
the first molar, the root may be cut off to the gum 
line and a Richmond crown, supported by a strong 
platinum pin, inserted. To prepare a root for a hol- 
low metal crown, all the enamel should be removed, 
and the tooth so trimmed that its greatest diameter 
will be at the cervical margin. At this point, the 
measurement for the band is taken with binding wire. 
This is accurately measured upon a piece of gold 
plate 29 or 30 gauge. A strip of gold is then cut the 



OPERATIVE DENTISTRY. 37 

desired width, is curled, and the ends sweated or sol- 
dered. This is placed upon the tooth root and 
marked to the festoon of the gum line. The band 
is then removed and trimmed to this line with 
curved shears. A cap is now swaged to articulate nicely 
with the occluding tooth, and is soldered to the band. 
The whole is then trimmed and polished. In pre- 
paring a root for the Richmond crown, the same prin- 
ciples are involved as to the beveling, measuring and 
cutting of the band, which, when soldered, is placed 
upon the root, festooned and driven to place by press- 
ure or tapping. The labial aspect of the root and 
band is now beveled down to a point beneath the gum 
margin to conceal the joint which is to be made be- 
tween gold and porcelain. A piece of No. 30 gauge, 
24 carat gold is burnished over the root and band. 
The band is now removed and soldered to the cap. 
The platinum pin is now thrust through the cap into 
the canal of the root. A porcelain facing is selected 
and ground to an approximate fit backed with 24 
carat, 30 gauge plate. Allow the backing to extend 
all the way to the gum margin. This should now 
be cemented to place upon the cap with hard wax, 
cooled and the whole removed. It should now be in- 
vested, the bulk of the wax picked out and the bal- 
ance allowed to burn awa}^ while heating up. Apply 
borax and solder with evenly distributed tempera- 
ture. The general principles in the construction of 
all crowns, which are modifications of these two men- 
tioned, are herein embodied. 

What (if any) possible evils may arise from pre- 



j8 OPERATIVE DENTISTRY. 

mature extraction of temporary teeth ? 

Malposition or impaction of the permanent teeth 
may result from premature extraction of temporary 
teeth. 

Name the different materials used in filling teeth, 
and the conditions in which the use of each is indicated, 
either separately or in combination. 

Oxysulphate of zinc is used in pulp capping. 
Oxychloride of zinc is used as a lining medium for 
very deep cavities covered with oxyphosphate of zinc, 
which in turn is an admirable cavity lining where 
caries has not approached too near the pulp. Ox}^- 
phosphate of copper is well adapted for cavities in 
children's teeth, where absolute dryness cannot 
be obtained, and is an excellent temporary stopping 
in teeth that do not admit of thorough excavation. 
Tin is a good filling material indicated in the teeth 
of children. Amalgam is used in posterior teeth and 
in invisible parts of anterior teeth, for nervous 
patients who cannot submit to long operations, also 
in frail teeth. Gold alone is only indicated where 
cavities exhibit strong hard surfaces. In combina- 
tion with the oxyphosphate of zinc and amalgam it 
may be used in nearly all cases. Gold and platinum 
in combination are indicated in large anterior cavities 
where the color of gold is objectionable. Gutta per- 
cha is used as a filling material for children's teeth, 
and is also well adapted for cavities near the gum 
margin, on the labial, buccal and lingual surfaces of 
the permanent teeth, and as a root canal filling. Par- 



OPERATIVE DENTISTRY. 39 

affine in combination with aristol is also employed for 
this last mentioned purpose. 

Give a general rule for the preparation of cavities 
before filling, and name the points that require special care 
in excavating. 

All overhanging, weak enamel margins should 
be trimmed away, and carions dentine removed from 
the cavity. The margins of the cavity should always 
be extended to a point where recurrent caries is least 
apt to occur. Grooves or dovetailed excavations should 
never be made in the enamel. Special care should 
be observed in excavating, not to encroach upon the 
pulp. If a layer of dentine over the pulp be decal- 
cified and not carious, it should be thoroughly steril- 
ized and allowed to remain. 

What are the diagnostic signs of dead pulp in a 
tooth ? How would you treat such a tooth and restore it 
to usefulness ? 

When a tooth fails to respond to applications of 
extreme heat or cold, the pulp is dead and should be 
extirpated. Extreme antiseptc precautions should 
be observed in this operation to avoid peridental in- 
volvement. The canals should be treated with so- 
dium dioxide followed by aromatic sulphuric acid, 
thoroughly dried with alcohol and warm air, or an 
electric root-drier, and filled. 

What is the usual cause of discoloration of teeth ? 
Describe in detail your method of bleaching. 

Discoloration of teeth is usually caused by death 
of the pulp and infiltration of coloring matter of the 



40 OPERATIVE DENTISTRY. 

red corpuscles into the dentinal tubuli. Apply rubber 
dam, remove all decalcified dentine, thoroughly cleans- 
ing the canals. Seal the apices of the canals with 
gutta percha. The cavity should now be thoroughly 
washed with a solution of caustic soda, and then dried 
with absolute alcohol and hot air. This drying pro- 
cess should continue until the dentine is thoroughly 
desiccated to a considerable depth. A pellet of cot- 
ton saturated with a 25% ethereal solution of py- 
rozone is now placed in the cavity and allowed to re- 
main for fifteen or twenty minutes. The cotton should 
then be removed, and the cavity again dried with hot 
air. This process should be repeated several times 
until the tooth is seen to become bleached, when a 
saturated solution of zinc chloride should be placed 
in the cavity and allowed to remain for a few mo- 
ments. The tooth should again be dried with alco- 
hol and hot air, and filled with dead white oxyphos- 
phate of zinc. After a few days, part of the zinc 
phosphate in the tooth crown is removed (not expos- 
ing the dentine at any point) and the tooth per- 
manently filled. 

What is pulpitis ? Give the etiology, symptoms 
and treatment. 

Pulpitis is the condition of a pulp which is un- 
dergoing the last stages of inflammator}^ change. It 
is caused by deep metallic fillings and traumatism ; 
first appearing as active hyperemia, then congestion, 
after which diapedesis and the pouring out of inflam- 
matory effusions occur. The symptoms are throb- 
bing pain and exaggerated response to heat. The 



OPERATIVE DENTISTRY. 4 i 

treatment consists in the administration of- anodynes, 
blood letting over the affected tooth, and sedative ap- 
plications to the pulp. The prognosis, however, is 
not favorable in these cases. 

How would you correct a case of excessive protru= 
sion of the upper teeth ? 

If there is not sufficient space to draw the teeth 
directly back into position, the first bicuspids should 
be extracted and the cuspids drawn backward by 
means of jack screws, until they occupy the vacant 
spaces made by the extraction. The four anterior 
teeth may now be drawn back simultaneously by 
rubber bands attached to a cap placed upon the occi- 
put. A retaining plate should be made to hold the 
teeth in position until they are firmly fixed. 

Give the treatment for a child ten years old whose 
central incisors are broken, so that the pulp is exposed. 

The essential consideration at this age is to con- 
serve the vitality of the pulp. The exposed parts 
should be bathed in peroxide of hydrogen, after which a 
capping of zinc oxide mixed to a paste with oil of cloves 
or campho-phenique is applied ; next several layers of 
an impervious varnish are placed over the capping 
and the operation completed with a zinc phosphate 
filling. At a subsequent period, that is, when the 
tooth is fully formed, a more lasting filling may be 
introduced. 

How should a congested pulp be treated ? 

A congested pulp, or one which is the seat of 
venous hyperemia, evidenced by a continued dull 



42 OPERATIVE DENTISTRY* 

pain, particularly responsive to heat, should be treated 
by first allaying the pain and then devitalizing. 

How should the margins of cavity wall be pre- 
pared for an amalgam filling ? 

The margins should be so prepared that the 
amalgam in its adaptation is not worked to a feather 
edge. 

What are the dangers attending the devitalization 
of pulps by arsenic ? 

Escape of the arsenic and destroying surround- 
ing tissue. 

How should arsenic be applied in cases where the 
cavity extends beneath the gum ? 

That portion of the cavity extending beneath 
the gum should be filled, arsenic should not be placed 
in a cavity beneath the gum, as leakage is very likely 
to take place in such location. It is better to make 
the application in such location as can, after devital- 
ization, afford ready ingress to the pulp canals. 

Give the best methods of keeping cavities dry. 

By the adjustment of rubber dam. At times the 
introduction of napkins is sufficient to keep cavities 
dry, as, for instance, in short operations in mouths 
which do not seem to collect the saliva in lar^e 
quantites. 

Give the recognized stages in the preparation of a 
cavity for filling. 

Securing proper space for the necessary work 
through separation. 



OPERATIVE DENTISTRY. 43 

Removal of all weak and overhanging walls. 

Removal of all decay and proper sterilization of 
cavity. 

Proper marginal preparation. 

Regard for possible pulp complications through 
conductivity and pressure of filling. 

Describe method of filling an occlusal cavity in molar 
with shallow sulci radiating from deep central cavity. De= 
scribe the form and condition of gold used in the operation. 

The cavity is enlarged to include all sulci so that 
when finally prepared it is star shaped. It may be 
filled with cylinders of non-cohesive gold, or with the 
cohesive variety either in the form of pellets or foil. 

Designate a class of cavities in frail teeth where a 
combination filling of gutta percha and zinc phosphate is 
indicated and give technic of operation. 

Cavities extending beneath the gum tissue. The 
gutta percha is placed in that part of the cavity situ- 
ated beneath gum tissue, and the zinc phosphate oc- 
cupies the remaining portion. 

Mention the causes of shock by cold or heat to 
teeth recently filled. Give treatment. 

Thermal deviations through metal fillings owing 
to improper protection of dentinal substance. A gutta 
percha cap may be adjusted over tooth, and counter 
irritants applied to gum ; if this does not effect a 
cure, the filling should be removed, sedatives applied 
in the cavity, the dentine properly protected by the 
use of an impervious varnish, after which the cavity 
is filled. • 



44 OPERATIVE DENTISTRY. 

What are the physical changes in an amalgam 
filling after its insertion in a tooth ? 

It hardens, changes its form and changes its 
color. 

Give treatment of inflammation of pulp in a su= 
perior central incisor that has a gold filling in good condi= 
tion in the approximal surface. 

An opening may be made from the lingnal sur- 
face where the basilar pit is located, and an arsen- 
ical application made ; after devitalization, the pulp 
is extirpated through this opening which is enlarged 
for the purpose. 

When the pulp of a tooth has sloughed leaving a 
discharge through the cavity of the tooth, how should 
the tooth be treated and filled ? 

It should be treated with peroxide of sodium or 
strong solution of formalin until every vestige of 
dead and decomposed tissue has disappeared. It may 
then be temporarily filled with concentrated solution 
of thymol on cotton and a temporary filling. If after 
four weeks everything appears satisfactory, the 
canals and cavity may be permanently filled. 



PROSTHETIC DENTISTRY. 

Describe the method of constructing a banded Lo= 
gan Cuspid Crown. 

After the root is properly prepared a facing of pla- 
tinum is accurately fitted to its surface. A band is next 
prepared and these two are soldered together. The 
labial aspect of the Logan Crown is ground to fit the 
root, so that when the crown is introduced into posi- 
tion, it will be found to fit the labial portion of the 
root, whilst lingually it will stand away from the 
root. The lingual portion of the crown next may be 
ground on a level after which a thin piece of platinum 
is perforated by the dowel and burnished against the 
base of the crown. A little hard wax is melted upon 
this piece of plate to keep it in position. The band 
and facing are placed in position upon the root and 
the Logan Crown is forced into place. The parts are 
then removed, invested, the hard wax is removed and 
solder poured in its place. 

What materials are used to produce the gum 
color in porcelain ? 

Principally purple of Cassius. 

Describe the method of repairing a continuous gum 
denture. 

The denture is first cleansed of any foreign sub- 
stance. This is best done by placing the denture in 
the oven and slowly heating to redness which car- 



46 PROSTHETIC DENTISTRY. 

bonizes all organic substances upon the plate. It is 
then thoroughly washed in soap and water. The 
broken tooth is next ground until the original stay is 
exposed. A new tooth is selected, accurately ground 
in position, backed and soldered to the original attach- 
ment. After this, the body is added and the case 
becomes just as good as when first made. 

Describe the process of sweating' together two 
pieces of gold plate of the same degree of fineness. 

The ends are beveled and brought together and 
by the careful application of heat may be united 
through partial fusion of surfaces in contact. 

What relation should the artificial teeth bear to 
the alveolar ridge? 

The tooth should be so arranged that its long 
axis is in line with the vertical axis of the ridge, to 
that the direction of force will be in the line of the 
centre of gravity. 

In retaining plate by the clasp method, is it better 
for the clasps to fit the teeth perfectly or merely to touch 
the teeth at several points ? State reasons. 

The clasps should be so fitted as to touch the teeth at 
as many points as it is possible to make them touch. 
This gives the greatest support. If the}' but touch 
the teeth at several points, they will soon, through 
wear, not touch at all and prove inadequate in main- 
taining the plate in position. 

Describe a denture for a person having sound 
canines and second molars. 

A horse shoe shaped plate may be constructed in 

such a case with clasps fitted to the second molars. 



PROSTHETIC DENTISTRY. 47 

What causes gold and silver plates to warp while 
soldering ? How may this warping be prevented ? 

It is caused by contraction of the solder. The 
plates should be firmly imbedded in an investing 
material. 

Why is platinum used for pins in teeth ? 

Its expanding and contracting ratio is about that 
of the porcelain teeth, and its high fusing point en- 
ables it to stand the heat of tooth baking. 

What gauge metal is used for an upper denture? 
What for a lower? 

About 26 for an upper, and preferably two thick- 
nesses of 30 or 32, soldered together, for the lower. 

Describe in detail the preparation of teeth for re= 
planting, transplanting and implanting, and your method 
of performing each operation. 

The tooth should be sterilized by immersing it 
in a 1- 1 000 solution of bichloride of mercury or 10% 
formalin. The contents of the pulp canal are re- 
moved and the canal is filled preferably with gutta 
percha, so as to seal out all foreign substances. After 
sterilizing the socket, the tooth is pressed into place 
and retained with a crib or splint. Sometimes the 
root is shortened as in cases of implantation. 

Replanting is replacing and securing in position 
a tooth which has been extracted for some pathologi- 
cal condition. This may be done after the socket has 
been prepared in a manner previously indicated. 
Transplanting is the process by which a tooth is ex 
tracted from one mouth and is placed into an existing 



48 PROSTHETIC DENTISTRY. 

socket in another month. Implanting is the process 
of inserting a tooth which has been extracted from 
another jaw, into a socket prepared by drilling 
into the bony strnctnre at a point where a tooth 
has been previously extracted. The general antisep- 
tic measures and treatment of the tooth referred to 
above shonld be carefully observed. 

Describe a method of repairing the gold plate when 
the only remaining incisor is to be extracted and replaced 
by an artificial substitute. 

After the removal of the tooth, the plate is re- 
placed and an impression is taken with plate in situ. 
When the model is made the plate will appear upon 
it. The soft tissne may be cnt away to allow for sub- 
sequent resorption and the tooth properly fitted and 
attached. 

Describe construction of a gold bridge to replace 
teeth lost between cuspid and second molar, both named 
teeth being in place and available. 

The natural teeth are properly ground, and, for 
the cuspid, a jacket is made ; while, for the second 
molar, a gold crown is prepared. 22-carat gold 
plate is employed. With these in position, an 
impression is taken ; after securing the proper 
articulation and shade of teeth, the model is 
made and the two jaws articulated. The facings 
are ground to properly fit, their cusps are re- 
moved, and gold cusps are prepared to take 

their places. This gives strength to the piece when 
completed. After backing the facings, the parts are 
invested, soldered and finished. 



PROSTHETIC DENTISTRY. 49 

Is there any objection to the use of silver in com= 
bination with vulcanite ? 

The sulphur in the rubber leaves the latjier and 
combines with the silver forming silver sulphid. 
The thin layer of the rubber being thus deprived of 
its sulphur cannot become vulcanized and remains 
soft. 

What would you do to prevent a plate from rock= 
ing in a mouth with a hard palatine ridge ? 

If the plate is vulcanite, it may be scraped at 
such points which rock upon the tissues. If metal, 
it may be reswaged by placing several folds of paper 
along the hard ridge on the die. 

How would you mix plaster of Paris for im= 
pressions ? 

Warm water may be used to hasten the setting 
of the plaster and material is added to the water 
until there appears to be no excess of water. For 
lower impressions it may be mixed slightly stiffer. 
A small quantity of sodium chloride on potassium 
sulphate may be used instead of warm water. 

flention the three principal ingredients used in 
manufacturing porcelain teeth and state which one gives 
translucency and lifelike appearance to the teeth. 

Kaolin, Feldspar and Silex. The Feldspar is 
used to produce the enamel and gives the translu- 
cency. 

What metal is used as a coloring agent to produce 
the grayish blue tint of the enamel of artificial teeth ? 

Platinum. 



jo PR OS THE TIC DEN TIS TR Y. 

State the relative merits of gutta percha and 
cement in retaining crown or bridge work in the mouth. 

Gutta percha is rapidly advancing in importance 
as a means of securing attachment for artificial 
crowns and bridges. It is insoluble, affords a means 
of ready removal in case such step is necessary, and 
acts as a cushion during periods of stress, preventing 
the fracture of porcelain facings. It has the good 
features of cement, with additional ones added, with- 
out the bad features of cement. Cement often proves 
irritating to the pulp, is brittle if used in small quan- 
tity and absorbs the fluids of the mouth and becomes 
offensive. 

Describe a method of obtaining a correct die from 
a lower model that has several anterior teeth standing, 
the jaw very much undercut lingually below the necks of 
the teeth. 

The teeth are cut down on the model, and, by 
making two cores approaching each other at the cen- 
tre of the model, we are able to accurately reproduce 
the model in either zinc or Babbitt's metal. 

What would result if an upper denture extended 
too far posteriorly and touched the palate ? 

In the act of talking or swallowing, movement of 

the muscular tissue of the soft palate would be likely 

to displace the plate, and at the same time cause 

retching. 

What is the difference between platinous gold and 
platinized gold ? 

Platinous gold is the alloy of gold and platinum. 
Platinized gold is a combination of gold on one side 



PROSTHETIC DENTISTRY. 51 

and platinum on the other, rolled together. 

What is plaster of Paris chemically ? How pre= 
pared for dental purposes ? 

Sulphate of calcium. Finely ground and de- 
hydrated. 

Give the fusing points of tin, zinc and lead. 

Tin, about 460 ° F.; lead, about 617 F.; zinc, 
about 7^° F. 

What is meant by the interdental spaces ? 

The triangular space between teeth partly occu- 
pied by gum tissue. 

Give method of striking up a partial gold plate. 

Having the die and counter-die prepared and the 
plate in the form ready for fitting, it is annealed and 
the portion projecting over the ridge for the support 
of the artificial teeth is first bent over, the plate is 
then worked into position by means of pliers and the 
mallet, and after it approximately fits the die, it is 
swaged between the die and counter-die. 
What is a metallic die? 

The reproduction of the model in metal. 
Give the fusing point of gold. 

202 1 ° Fahrenheit. (Hodgen.) 

Describe your method of crowning the root of a 
superior central incisor. 

The Richmond crown is here indicated. The 
root is properly prepared and sides dressed and 
a platinum piece is fitted to its face. If the crown 
is to be made with a full band, then this part is next 



$z PROSTHETIC DENTISTRY- 

fitted and soldered to the platinum facing. If the 
half band is made, it is made at the same time the facing 
is fitted to the root. The platinum is allowed to ex- 
tend beyond the lingual aspect and bent over, and by 
cutting a V into this extension it may readily be 
formed into the half of a band. , The dowel is next 
adjusted in the enlarged pulp canal and the dowel 
and facings are soldered. It is then placed in posi- 
tion (taking a wax bite) and if everything is properly 
related, an impression is taken with the adjoining 
tooth on each side represented and a model made. A 
facing is next selected, ground, backed, invested and 
soldered. 

What carat solder is obtaind by fusing together 10 
parts pure gold, 3 parts copper and 2 parts silver? 

Carrying the proportion contained in the above 
to 24 carat, it represents 16 carat solder. 

Can you solder an 18 carat plate with 20 carat 
solder ? Explain. 

As the 20 carat solder has a fusing point slightly 
above the 18 carat plate, there is every likelihood of 
fusing the plate in the attempt to make the solder 
flow. 

What is the substance known as vulcanite ? 

It represents the caoutchouc minus its hydrogen 
which the admixed suphur removes in the process of 
vulcanization. 

Give the method of setting a Bonwill Crown. 

The dowel is first set with amalgam or zinc 
phosphate and allowed to project beyond the face of 



PROSTHETIC DENTISTRY. 53 

the root so that it may extend into the perforation 
fonnd in the Bonwill Crown. The crown may then 
be set with either of the above materials. 

When should plain and when should gum teeth 
be used ? 

The gnm tooth is employed when the patient, in 
laughing or talking, markedly displays the teeth. 
The artificial gum more closely resembles the natural 
gum than vulcanite. Plain teeth are employed when 
the reverse is the case ; they may then be embedded 
in vulcanite, and as the lip effectually covers the 
rubber, it is hidden from view. 

Give the fusing point of silver. 

About 1904 Fahrenheit. (Hodgen). 

Describe the best method of re=enforcing the por- 
tion of a gold plate, lower partial, that crosses behind the 
six anterior teeth. 

By swaging an extra piece of gold plate to fit the 
lingual aspect and rest about one-third up on the 
teeth and solder this to the plate. 

State some of the first considerations in exami- 
nation of the mouth preparatory to making an artificial 
denture. 

The mouth is examined as to its condition of 
health. Diseased roots that are beyond being made 
useful should be removed. The question of permit- 
ting the cuspid roots to remain in place requires 
serious consideration. A molar, or a molar on one 
side and a bicuspid on the other, will be found very 
useful in keeping the denture in place. These 



Si PROSTHETIC DENTISTRY. 

points, as well as the existence and relation of soft 
and hard tissues, should be duly considered. 

State how plaster may be prevented from dropping 
into the throat while an impression of the upper jaw is 
being taken. 

By having the patient lean forward, or in adjust- 
ing a heel of wax to the impression tray. 

State the percentage of caoutchouc and of sulphur 
used in making vulcanizable rubber .suitable for dental 
plates. 

Caoutchouc 48 parts, sulphur 24 parts. 

Should gold clasps be used about a tooth contain- 
ing a large amalgam filling? Explain. 

The gold in apposition with the amalgam is apt 
to produce a galvanic current and shock the pulp. 

State two essential requirements for the produc- 
tion of a perfectly fitting artificial denture. 

An accurate impression and an accurate model. 

How should a plaster model be treated when a 
portion of the ridge is soft and the centre of the mouth 
hard ? 

The soft portion should be slightly scraped to 
produce compression when the plate is introduced. 

State some of the causes of fracturing porcelain 
teeth during the process of soldering. 

Not sufficiently heating the teeth before attempt- 
ing to make the solder flow. In cooling too quickly 
the tooth contracts before the pins have contracted. 
By allowing borax to come in contact with the por- 
celain during soldering. 






PROSTHETIC DENTISTRY. 55 

Describe the difference between long bite teeth and 
short bite teeth. Hention cases where each would be 
appropiate. 

Long bite teeth have a much greater distance 
between the occlusal surface and the pins than be- 
tween the pins and the cervical border. In short bite 
teeth the reverse holds good. Long bite teeth are 
indicated where the natural teeth in one jaw bite up 
close to the alveolar ridge in the opposite jaw. Short 
bite teeth would be appropriate in a long alveolar 
ridge and short lip. 

Which is finer, 20 carat plate or 20 carat solder ? 
Which fuses at the lower degree of heat ? Why ? 

Both have 20 parts of pure gold in 24. The 
solder fuses at a lower degree of heat than the plate, 
because zinc is incorporated with it. The gold plate 
has no zinc. 

How may rubber be prevented from entering the 
joints between gum sections ? 

By filling up the spaces with oxychloride of 
zinc. 

Give some of the uses of zinc, lead, Babbitt's 
metal. 

Zinc is used as a die in the swaging of metal 
plates. Lead is used as the counter-die in the swag- 
ing of metal plates. Babbitt's metal is used as a 
die particularly in cases where we do not wish any 
contraction of the die to influence the fit of the plate, 
as in the case of zinc dies. 

Give a method of removing a Richmond Crown in 
order to repair the broken porcelain. 



jd PROSTHETIC DENTISTRY. 

The backing maybe grasped in the beak of a 
forceps and by a gentle rotation loosened and re- 
moved. If the crown is set with gutta percha, a 
warm instrument may be held in contact with the 
backing and the gutta percha sufhcently softened in 
this way to allow of the removal of the dowel, or drill 
through the cap and sever the dowel. 

What is the best investment for crown and bridge 
work ? 

Combination of plaster, 3 parts ; marble dust, 2 
parts ; and clay, 2 parts. Some advise adding 
pumice. 

How soon after extraction of teeth should a plate 
be inserted ? 

The temporary plate may be introduced from 
four to six weeks after extraction. The permanent 
from between six to twelve months. 

What is the guide in the selection of artificial 
teeth ? 

The temperamental characteristics of the patient 
will guide us in the selection of color, size and shape. 
The length of ridge and the difference in length be- 
tween the high and low lip line will determine whether 
we use a short or long bite tooth, a plain or gum 
tooth. 

What is the guide as to the amount of rubber to 
be packed in a case ? 

If the case has been carefully waxed, the wax 
when removed may be weighed, and, by using an 
amount of rubber just slightly in excess of this, we 



PROSTHETIC DENTISTRY. 57 

closety approximate the amount of rubber needed. 
Or, in bringing the two halves of the flask gradually 
together, the surplus may, by opening the flask from 
time to time, be trimmed away until finally there 
remains about the correct quantity of rubber. 

Should light shades of teeth be selected for the 
blonde or for the brunette ? Why ? 

The various pigmentary deposits throughout the 
system are generally harmonious. In the blonde we 
are apt to find light shades in teeth to correspond 
with the color of the skin and hair. Dark shades 
would be inharmonious in the blonde, and vice versa. 

How should the loss of a superior lateral incisor 
be replaced ? 

A jacket is made for the cuspid and to this the 

artificial lateral is attached. 

Give a method of making a gold clasp. 

Gauge about No. 24 is selected and adapted to 
that portion of the tooth determined by its shape. If 
the tooth be a bicuspid or molor a lug is fitted in an 
occlusal groove to prevent the clasp from working up 
and irritating the gum tissue. 

What effect on the shade of teeth has platinum 
backing and a gold backing ? 

Platinum tends to darken. the shade of the tooth. 
Gold tends to brighten it. 

Why is silver not used in crown and bridge 
work ? 

Crowns and bridges generally being fixed, 
the oxides and sulphides that would form could not 
be properly removed. 



SS PROSTHETIC DENTISTRY. 

What is the amount of alloy in American gold 
coin ? 

American gold coin being" about 22 carat fine, 
the amount of alloy would be about two parts. (21.6 
carat.) 

Give the method of cleaning and sterilizing burs. 

The adherent detritus may be removed by means 
of the wire brush, after which they are subjected to 
the heat of boiling water for thirty minutes, rendered 
alkaline by the addition of soda, or, are immersed in 
10% formalin for 20 minutes. 

Describe the size, shape and shade of teeth suit- 
able for a person of bilious temperament. 

Large square teeth, angular cusps, close con- 
tact, and of a bronze yellow shade. 

What are the advantages of the continuous gum ? 

Cleanliness and the better artistic restoration of 
the lost parts. 

What is a counter=die ? 

The reverse of the die. 

Describe an air chamber as to size, shape and posi- 
tion. 

The air chamber, or more property, the vacuum 
chamber, is generally located from the point back of 
the rugae to about one-quarter of an inch from the 
posterior border of the plate. It describes the out- 
lines of the plate. 

Name the objections to the use of celluloid as a 
base plate. 



PROSTHETIC DENTISTRY. 59 

Instability, porosity, loss of color and warping. 

Describe Brown's Porcelain Bridge, stating ad- 
vantages and disadvantages. 

The Brown Bridge consists of porcelain teeth 
connected by a bar of iridio-platinnm, and, subse- 
quently, united to this metal and to one another by 
the fusing of porcelain. Its advantages are that there 
does not exist the same liability to fracture as is 
found in the facings used in the ordinary bridge, and 
furthermore, it is supposed to be more cleanly. Its 
decided disadvantage is that, in the majority of cases, 
anchorage is secured by drilling cavities into natural 
teeth and fitting extensions into these cavities. 

Give method of setting a Richmond Crown. 

This crown may be set either with zinc phos- 
phate or gutta percha. If this crown is made with a 
full band, care should be exercised that no surplus 
material is allowed to irritate the pericementum. 

What is the best method of taking partial im= 
pressions ? 

For partial plates, impressions may be taken in 
wax and plaster. The impression being first taken 
in wax, then having the palatal portion trimmed 
down to allow of a small quantity of plaster being 
placed in position, after which the tray is reintro- 
duced and we have easy withdrawal with an accurate 
impression of the roof of the mouth and teeth. 

What advantages, if any, have Richmond Crowns 
over other crowns ? 

The Richmond Crown admits of accurate adap- 



So PROSTHETIC DENTISTRY. 

tation against the face of the root, producing a natural 
effect, and, by means of the half band, or in some 
cases the full band, prevents fracture of the r6ot. 
The gold employed also adds strength. 

What may be said in favor of pinless teeth ? 
Against them ? 

The pinless teeth possess the advantages of admit- 
ting of easy repair in case of fracture ; not having 
the gold backing, they present a cleaner surface and 
have a more natural appearance/ The disad- 
vantage seems to be, that in the anterior portion of 
the mouth very frequently the tube is too far front 
and the tooth does not entirely cover the face of the 
root. 

Give the fusing point of copper. 

About 2,ooo° Fahrenheit. 

Of what is Babbitt metal composed ? 
Copper, i part ; antimony, 2 parts ; tin, 8 parts. 

Where and how is crude rubber obtained ? 

Caoutchouc is a milky exudate from several spe- 
cies of trees found in tropical countries. The juice 
is collected and heated to drive off the water and 
allowed to stand, becoming elastic when exposed to 
the air. 

Give the method of obtaining an impression of a 
perforated, hard plate. I 

Plaster mixed quite stiff is carried into the nasal 
cavity and made even with the borders of the fissure. 
The tray with additional plaster is then introduced. 



PROSTHETIC DENTISTRY. . 61 

At the first sign of setting, by a quick sudden move- 
ment, the impression can be made to separate at the 
line of the fissure. Afterwards, the two portions of the 
impression can be united. 

Give formula for silver solder. 

Silver, 3 parts ; brass, 1 part. 

What would be the effect of placing a piece of lead 
on a gold plate during the process of annealing? 

It would combine with the gold, and, by forming 
an alloy of a considerably reduced fusing point, it 
would burn a hole in the plate. 

Does absorption of the a veolar process advance 
more rapidly with or without a plate ? 

Without a plate absorption advances more evenly 
and quickly than when a plate is worn. 

In soldering a small piece of gold to a larger piece 
on which should the solder be placed ? Why ? 

By placing the solder on the larger piece of gold 
we may more readily invite its flow towards the 
smaller piece, because the larger piece is harder to 
heat up than the smaller piece. 

When vulcanite upper plates crack, why does the 
crack usually occur at or near the median line? 

Because the sides of the alveolar ridge are ab- 
sorbed and the median ridge of hard palate is not. 

Give the method of polishing a vulcanite plate on 
the palatine surface. 

Use. fine pumice and brush wheel. 

Can rubber attachments be placed equally well on 
gold, silver, or platinum base? 



62 PROSTHETIC DENTISTRY. 

Rubber attachments can be made with, these 
metallic bases. Platinum, on account of the absence 
of rigidity, does not answer well unless alloyed with 
some metal. Silver requires the protection of some 
intervening tin foil, so that the sulphur of the rubber 
will not affect it. Gold is probably the best. 

Mow should faults be corrected in the articulation 
of artificial teeth ? 

If we carbonize the occlusal surface of the teeth 
of one jaw, they will show the points at which they 
touch first when articulating the two jaws. This 
may be repeated until they come evenly in contact. 

Give a formula for 2o=carat gold plate. 

Pure gold, 20 parts ; copper and silver each 2 
parts. 

Describe the method of obtaining a correct bite for 
a full upper and lower set. 

Having the proper contour of lips and cheek and 
correct lengths, the patient's head is inclined back- 
ward and pressure exerted against the chin to pre- 
vent biting out. The patient may be asked to swal- 
low or hold the tongue back towards the pharynx. 
This, in a measure, prevents the common tendency 
of biting out with the lower jaw. 

Describe fully the method of preparing a molar 
tooth for a gold crown. 

Sufficient tooth structure must be removed to 
make the tooth fully as wide, if not wider, at the cer- 
vical border as at any other point upon the crown. 
This is generally accomplished by the use of the 



PROSTHETIC DENTISTRY. 63 

diamond disk and corundum, carborundum or gem 
wheels of varying sizes. 

In the case of healthy central incisor roots, 
should Bonwill, Richmond or Logan Crowns be adjusted ? 
Give reasons for your choice. 

The Richmond Crown is the best, because it ad- 
mits of best adaptation to the root, possesses strength, 
and, by means of the half band or full band, prevents 
fractnre of root. The Bonwill Crown is too fragile. 
The Logan Crown is serviceable, but does not allow 
of the same accurate apposition with the root as the 
Richmond, and does not, unless prepared with a band, 
prevent fracture of root. 

How is gold solder confined to the desired sur- 
face? 

By careful application of borax of proper consis- 
tency. Proper application of heat, or, by coating sur- 
face not desired to have solder flow to, touched with 
a little jewellers' rouge. 

Describe a gold plate with a rubber attachment. 

The plate is swaged in the ordinary way, and, 
after the borders of the plate have been accurately 
marked, gold wire is soldered a^ong the alveolar 
outline and at the line of the termination of the rub- 
ber. This insures support to the rubber and makes 
likely a more acceptable finish. At selected points, 
gold wire is soldered to the plate ; or, scrap gold may 
be used. These are so arranged as to form a secure 
attachment for the rubber. The teeth are arranged 
as in any other case, after which it is vulcanized. 



64 PROSTHETIC DENTISTRY. 

Give a formula for a 22=carat solder. 

Gold, 22 parts; copper, i part; silver, ^ of i 
part ; zinc, J4 of i part. 

State the reasons for using black, red, and pink 
rubber. 

It is claimed that black rubber is not so apt to 
prove as irritating as other varieties. The pink rub- 
ber more closely resembles the gum tissue and is 
used in the anterior part of the mouth. When the 
black rubber is objectionable, on account of its color, 
red rubber is used. 

What base for an artificial denture do you con= 
sider hygienically the best, and why ? 

Platinum covered with porcelain, commonly 
known as " continuous gum." On account of its 
thermal conductivity, lack of porosity and absence of 
spaces for accumulation of food particles. Gold plate 
with vulcanite attachment comes next in order of 
hygienic value. 

Describe the method and material you would use 
to secure a perfect model of the inferior maxilla when frac= 
tured. 

Take plaster impression of parts as found, and 
make plaster model. 

When the superior cuspids are outside a contracted 
arch, how would you expand the arch and bring them 
into position ? 

Expand laterally with coffin split plate, or, with 
bands on each side of arch with bent piano wire 
spring reaching from one side to the other. Or, in- 



PROSTHETIC DENTISTRY. 63 

stead of piano wire spring a jackscrew may be used. 
With vulcanite plate covering the arch, a spring may 
be passed outside of the arch on each side to rest 
upon and press cuspids inward. 

What general principles should be observed in 
arranging artificial teeth for an edentulous mouth ? 

1. Teeth should be of proper shade and size 
to suit the special case. 

2. They should be so arranged as to occlude 
properly. 

3. They should restore the expression of mouth 
and face. 

4. They should be so placed as not to keep jaws 
too far apart, or, to allow them to come too close 
together. 

5. To avoid tilting, teeth should be situated as 
nearly on centre of ridge as possible. 

Describe method of attaching metal clasps to vul= 
canite plates. 

Bend clasp to shape. Solder an ear or extension 
to it pointing toward the centre of the mouth. Punch 
holes in ear, fit it tightly to plaster tooth and vul- 
canize it to the plate. 

Can rubber be vulcanized in contact with silver? 
Give explanation. 

If the rubber is in direct contact with silver, in 
the process of vulcanization, the sulphur will attack 
the silver, for which it has great affinity, and will not 
properly remove the hydrogen from the caoutchouc, 
leaving the latter in a softened condition. 



66 PROSTHETIC DENTISTRY, 

When an upper impression is to be taken, state 
the position of (a) the patient, (b) the operator. 

The patient is placed with head forward so as to 
prevent any plaster, if this material be used, from 
entering into the trachea. The operator is back of 
the patient. 

What relation in regard to length should (a) thie 
upper teeth bear to the upper lip, (b) the lower teeth bear 
to the lower lip ? 

The superior incisors are placed so as to extend 
about 1-16 or 1-32 of an inch below the upper lip. 

The inferior incisors are placed about the same 
distance below the lower lip. 

In articulating a full denture, what teeth should 
bear the greatest pressure of the bite ? 

The posterior teeth. 

The impression being ready, tell how to make the 
cast. 

The plaster is mixed to the proper consistency 
and a small amount is placed at the highest point of 
the impression, and carefully permitted to run into 
all parts of the impression, particularly into the im- 
pressions of any teeth. In this way a perfect model 
of all parts is secured. The air is thoroughly forced 
out and air spaces are avoided. Enough plaster must 
be added to give requisite strength to the model ; and,, 
by inverting the impression and plaster, and placing 
it upon a smooth surface, preferably glass, an even 
base surface is produced. 

About what degree of heat is required to fuse por- 
celain in continuous gum work ? 



PROSTHETIC DENTISTRY. 67 

About 2600 F. 

Describe the method of constructing a porcelain 
faced bicuspid crown. 

A band or ferrule is prepared as for the hollow 
metal crown, the buccal portion is cut out, leaving 
the band intact at its cervix to a depth of about 1-16 
of an inch. A cross pin cuspid tooth is selected and 
accurately ground to fit the portion of the band cut 
out. Its sides are then beveled and a backing of 30 
gauge gold plate adjusted. This is held in position 
by means of hard wax applied within the band. An 
investment of plaster and marble dust is made, the 
hard wax removed, and the tooth soldered to the 
band. Having secured the articulation, the cusps 
are next prepared, secured in proper position, the 
different parts invested and soldered. 

How are teeth attached to the platinum plate in 
continuous gum work ? 

After the teeth are ground into position, they are 
secured in place by an investment ; the wax is removed 
and the platinum plate is so arranged that it is in contact 
with the plate proper as well as with the bent pins of 
the teeth. Pure gold is used to solder the parts. 

Why is the lower denture more troublesome than 
the upper denture ? 

There is little alveolar ridge, and there are ab- 
sent the advantages accruing from the presence of a 
vacuum chamber. 

What is weighted rubber, and where is it used ? 



68' PROSTHETIC DENTISTRY. 

Rubber prepared with tin filings to give the 
finished plate additional weight,. Used in lower cases 
to overcome the ten den cv of the muscles and the sub- 
lingual tissues to displace the plate ; or, where the 
bite is unusually short and the stress is liable to 
fracture, the ordinary vulcanite plate. 

Mention the most desirable carat and gauge of 
plate for crowns. 

22 K, gold; 30 gauge. 

In full dentures, are the upper or the lower teeth 
first arranged on the model ? Why ? 

The upper teeth are first arranged. Having the 
proper fullness of lips and cheek and proper lengthy. 

the upper teeth are ground into position, having the 
upper properly arranged, the lower set may then read- 
ily be ground to correctly articulate with the upper. 

State what causes gum sections to break in the 
flask. 

Generally due to excessive force employed in 
screwing down the flask. 

What is the fusing point of aluminum ? 

About 1200 F. 

What causes dark joints in gum teeth ? 

Not having filled the spaces between the joints, 
with some material that prevents the entrance of rub- 
ber in vulcanizing. 

What causes the tissues to infiame under a rub= 
ber or celluloid plate? 

Some claim that as these materials are very poor 

conductors of heat they permit an increased heat in 



PROSTHETIC DENTISTRY. 69 

the parts. More likely it is due to the irritation of 
septic matter which finds lodgment on the surface of 
the plate next to the roof of the mouth. 

State what you consider the most unfavorable 
conditions for wearing artificial teeth ? 

Mouth with shallow arched and narrow alveolar 
ridges, where it is difficult to procure the effects of 
a vacuum chamber, and where the two jaws are re- 
lated as in marked superior or inferior protrusion. 

Describe the size, shape and shade of teeth suit= 
able for an elderly man of lymphatic temperament. 

Large, broad, ill shaped and flat, yellow color. 

Describe the teeth suitable for a young woman of 
nervous temperament. 

Small, or medium, conical, pearl blue or grey in 
color. 

How should an aluminum plate with rubber 
attachment be made ? 

The plate is swaged, care being taken not to 
fracture the metal either by overheating it in the an- 
nealing process, or by too forcible swaging ; the wire 
for holding the rubber is next soldered in the position 
it is to occupy. The soldering is difficult and is only 
correctly executed after the exercise of much care and 
time. After this, the teeth are arranged in the ordi- 
nary manner and the case vulcanized. 

Mention conditions which render the extraction of 
teeth advisable. 

Excessive looseness through loss of pericemen- 
tum or alveolar walls ; or, the seat of such disease 



jo PROSTHETIC DENTISTRY. 

which renders likely their early loss; or, a single in- 
cisor tooth which, if allowed to remain, would make 
difficult the arrangement of the artificial set, and fur- 
thermore enhance the artificiality of the new teeth. 

Describe the operation of extracting incisors, cus= 
pids, bicuspids and molars. 

All teeth with single and rounded roots are re- 
moved by a rotary movement. Those with flattened 
single roots by an in and out movement. The su- 
perior molars are removed by an out and in move- 
ment. The out being first employed. The lower 
third requires an up and back movement. 

Flention some of the accidents which may follow 
the extraction of the teeth. 

Fracture of roots, or of maxillary bones ; injury 

to gum tissue, infection of socket through lack of 

antiseptic precautions. 

flention some of the conditions which necessitate 
special precautions in extracting teeth. 

Crowded teeth where the forceps cannot be prop- 
erly adjusted. Impacted teeth. Crowns with frail 
walls require special precautions to prevent fracture. 

What kind of a denture should be constructed in 
the case of a patient whose superior canines and second 
molars are in position ? 

By devitalizing the pulps of the cuspids, remov- 
ing the crowns and preparing Richmond crowns for 
the roots, and then preparing hollow metal crowns 
for the second molars ; a bridge may be constructed 
extending from molar to molar, or a horseshoe plate 
ma} r be made with clasp fitted to the second molars. 



PROSTHETIC DENTISTRY. yi 

How should the loss of a superior lateral incisor be 
supplied in the case of a young woman ? 

It may be implanted ; or, by preparing a 
jacket for the cuspid and accurately fitting it, and so 
arranging it that only a very narrow width of gold is 
visible labially ; or, by the later method in connec- 
tion with which no gold is visible, an incisor may then 
be attached to the jacket. 

How are porcelain teeth attached to a metallic 
base ? 

By adjusting a backing, and then, by means of 
solder, attaching this backing to the pins and plate ; 
or, by having a rubber attachment to the metallic 
base and securing the tooth by means of this attach- 
ment. 

Give reasons for your preference of gum teeth or 
of plain teeth in full dentures. 

When the patient in laughing or talking largely 
displays the natural gum, then gum teeth should be 
used as this more closely resembles the natural gum 
than any other material. 

What is the fusing point of platinum ? 

About 3500 F. 

Give method of taking an impression of a root 
for a gold crown. 

Thin wire is adjusted around the root and drawn 
together until it measures the root circumference. 

If the inferior centrals are absent, how may the 
loss be supplied without a plate ? 



72 PROSTHETIC DENTISTR K 

A jacket may be constructed for each lateral and 
the missing incisors fitted into place and soldered to 
jackets. 

How may a gold clasp be attached to a rubber 
plate ? 

After the metal is fitted to the tooth, at a con- 
venient point, is soldered an extension of gold or 
clasp metal. This extension is carried into the sub- 
stance of the rubber, and, in being perforated at sev- 
eral points, is securely held in place. 

How may plaster teeth on models be strengthened 
to prevent fracture ? 

By forcing a pointed wire or ordinary pin into 
the impression. When the model is run each tooth 
has this support extending into the model as well as 
through the tooth. 



ORAL SURGERY. 

What conditions are necessary to obtain bony 
consolidation after fracture ? 

Accurate apposition of the fractured surfaces 
without the interposition of pieces of muscle, connec- 
tive tissue or an excessive amount of blood clot, im- 
mobilization for a sufficient length of time, sufficient 
blood supply to both fragments, sufficient innerva- 
tion, absence of surface inflammation and constitu- 
tional causes of non-union. Asepsis is greatly to be 
desired, but bony union can occur in suppurating 
wounds by a process analogous to the healing of 
wounds by second intention. 

In what stage of inflammation is cold a valuable 
remedial agent ? Give reasons. 

Cold is a valuable remedial agent in the begin- 
ning of inflammation since it causes a contraction of 
the blood-vessels and therefore lessens the amount of 
blood in the part. If applied for too long a time, it 
lowers the vitality of the tissues, promotes stasis, and 
interferes with the ameboid action of the leucocytes. 

At what age are the best results obtained from 
operations for cleft palate ? Give reasons. 

The best results are obtained by operating be- 
tween the second and third years. It is not advisable 
to operate upon infants since they stand hemorrhage 
poorly, suck the stitches and disturb them with the 



7/ ORAL SUR GBR Y. 

tongue, and because the tissues are delicate aud fri- 
able. It should not be deferred later than the period 
indicated as bad habits of articulation will be con- 
tracted and subsequent success, as gauged by the 
quality of the speech, is much less likely to follow. 
Differentiate lacerated and contused wounds. 

A lacerated wound is a wound produced by a 
tearing of the tissues. 

A contused wound is a wound produced by a 
bruising of the tissues. 

In practice the distinction is not well drawn, 
since the edges of most lacerated wounds are also 
more or less contused. 

State the predisposing causes of lingual carci= 
noma. 

. Age of the patient (past 40), any irritation, such 
as a sharp tooth, the stem of a pipe, or a badly .fitting 
plate ; psoriasis and scars produced by syphilis, in- 
jury, or any other cause ; smoking. 

What are wounds and how are they classified ? 
A wound is a solution of continuity of an exter- 
nal or internal surface of the body. 

Wounds are classified as follows: Incised, 
lacerated, contused, punctured, poisoned and gun- 
shot. 

Give varieties of fracture of the inferior maxilla. 

Through the body of the bone in the neighbor- 
hood of the mental foramen, at the angle or within 
the vertical ramus, through the neck of the condyle;, 
and at the base of the coronoid process. 



ORAL SURGERY. 75 

Describe the operation for ligating the facial artery. 

After all aseptic precautions have been carried 
out, a horizontal incision, one inch in length, is made 
directly over the vessel as it crosses the lower border 
of the jaw immediately in front of the masseter. The 
incision divides the integument, the fascia, and the 
platysma myoides. In making the incision, the skin 
should be drawn upward over the bone, so that when 
the skin retracts, the scar will not be visible upon the 
face. The vessel is ligated just as it emerges from 
the substance of the submaxillary gland. The aneu- 
rism needle is passed from behind forward. 

What is anesthesia ? 

Anesthesia is a condition of total or partial in- 
sensibility, particularly to touch. 

Define synovitis. Give symptoms and treatment. 

By synovitis is meant the inflammation of a 
synovial membrane. 

Symptoms. — The joint becomes the seat of lan- 
cinating pain and is filled with fluid. If the articu- 
lation is superficial, the overlying skin may be hot 
and hyperemic. There is a spasm of the surround- 
ing muscles, causing the joint to be held in that posi- 
tion which affords the greatest ease to the patient. In 
some cases, the muscles controlling the joint undergo 
a rapid atrophy. If suppuration occurs, the overly- 
ing integument becomes dusky red and edematous. 
The pain becomes throbbing in character, and the 
individual is frequently awakened at night by start- 
ing pains in the extremity. The temperature is high 
and there is emaciation. 



j6 ORAL S UR GER Y. 

Treatment. — Immobilization. In the early stages 
and in young people, cold is of value (evaporating" 

lotions, ice bag r Leiter's tubes). Later on, warm fo- 
mentations may be used or a few leeches applied. If 
painful distention is present > some of the fluid may 
be aspirated under strict aseptic precautions. Should 
suppuration occur, the joint must be opened, irri- 
gated, and a rubber drainage tube introduced into- 
the most dependent portion. 

Any underlying diathesis should receive appro- 
priate constitutional treatment. 

Descrbe the ape rati an far I i gating the temporal 
artery. 

Make a vertical incision one incli in length, a 
half inch in front of the tragus, and just above the 
zygomatic arch. Divide skin, superficial fascia and 
deep fascia, and then feel for the pulsation of the 
vessel. The aneurism needle is to be passed from 
behind forward so as to avoid the temporal vein and 
the auriculo-temporal nerve. 

Give the varieties of gangrene. 

i. Symptomatic gangrene : embolic, senile, dia- 
betic, Raynaud's disease, ergotic. 

2. Traumatic gangrene : direct and indirect. 

3. Infective gangrene : acute rapidly spreading 
gangrene, hospital gangrene, necrosis of bone, noma 
and cancrum oris, carbuncle and boil. 

4. Thermal gangrene : frost-bite, burns, and 
scalds. 

Name the different methods for arresting arterial 
hemorrhage. 



ORAL SURGERY. 77 

Direct pressure, acupressure, forcipressure, tor- 
sion, cauterization, and ligation. 

Is necrosis found more frequently in the inferior 
or in the superior maxilla ? Why ? 

Necrosis is found rather more frequently in the 
inferior maxilla because its blood supply is not so 
abundant. 

Differentiate a syphilitic ulcer of the tongue 
from a traumatic ulcer of the tongue. 

Syphilitic ulcer. — There is a superficial crack or 
fissure upon the side or tip of the tongue. Such fis- 
sures may be multiple, chronic, or relapsing. It is 
common in the secondary period of the disease, and 
is often accompanied by mucous patches, by similar 
ulcers upon the cheeks, or by papular eruptions upon 
the skin. It improves under specific treatment. 

Traumatic ulcer. — The ulcer is usually situated 
upon the side of the tongue, is ragged or irregular in 
outline, and is usually opposite a collection of tartar, 
an angle of a tooth, or the edge of a plate. The 
glands are not enlarged. Recovery follows the re- 
moval of the local irritant. 

Define orthodontia. 

By orthodontia is meant the correction of irregu- 
larities of the teeth. 

State the best method of sterilizing instruments. 

The best method of sterilizing instruments is to 
boil them for ten minutes in a \% solution of sodium 
carbonate. 

What are the causes of secondary hemorrhage ? 



78 ORAL SURGERY. 

Chief cause, — septic arteritis. 

Contributory causes : i . Early absorption of 
ligature. 2. Faulty application of ligature. 3. Liga- 
ture too near a collateral branch. 4. A diseased 
condition of the arterial wall. 5. A state of blood 
unfavorable to repair of any wound (albuminuria or 
diabetes). 6. Increased blood pressure (plethora, 
Bright's disease, fever, injudicious excitement, or un- 
wise administration of stimulants). 

Define staphylorrhaphy. State the most favor= 
able age for the operation. 

By staphylorrhaphy is meant the plastic opera- 
tion for closing a cleft in the soft palate. 

The most favorable age for the performance of 
the operation is between the second and third year. 
It is very important that staphylorraphy should be 
performed before the child commences to talk. 

flention two methods of preserving the aseptic 
character of a wound. 

The aseptic method and the antiseptic method. 
Give etiology and treatment of syncope. 

Syncope is due to anemia of the brain produced by 
sudden failure of the heart's action. 

Lay patient flat on his back with the head low. 
Make friction over the praecordial region or apply 
galvanism. Put smelling salts to nostrils and give 
a little brandy as soon as the patient cau swallow. 

Give the clinical appearance and treatment of 
osteoma of the inferior maxilla. 



ORAL SURGERY. 



79 



Osteoma of the inferior maxilla may consist either 
of a general thickening or enlargement of the entire 
bone or of a local outgrowth. The tumor is ex- 
tremely hard, grows slowly, and causes no pain un- 
less it presses upon important sensory nerves. The 
neighboring lymphatic glands are not enlarged. 

Treatment. — These tumors are best let alone 
unless the deformity is great or the movements of 
the mandible are interfered with. They may be par- 
tially excised, the offending portions being chiselled, 
drilled, or ground away, or they may be wholly re- 
moved by excising a portion of the mandible. 

Describe suppurative cellulitis. 

The affected part is hot, tender, and infiltrated ; 
if superficial, it looks red and angry and is brawny 
to the touch. Fever is usually present and, in severe 
cases, one or more rigors may occur. If the part is 
not incised, the process rapidly spreads throughout 
the entire extremity or region ; the toxic fever rapidl} T 
exhausts the patient's strength and the entire sub- 
cutaneous and intermuscular areolar tissue of the 
part is destroyed. 

Define surgical shock. Give the treatment. 

Surgical shock is the immediate constitutional 
effect of an injury. 

Treatment. — When slight, rest in the recumbent 
posture and the exhibition of some aromatic stimulant 
(ammonia). If severe, recumbent position with the 
head low ; surround the patient with hot bottles (well 
protected) and blankets to maintain and bring up 



80 ORAL SURGERY. 

body-temperature. If conscious and able to swallow, 
give a little warm tea or stimulant ; if unconscious, a 
small hot coffee or brandy enema, or a hypodermatic 
injection of ether or strychnine. Care should be 
taken not to waste vital pow r er by over-stimulation 
which will result in excessive reaction. The intra- 
venous injection of normal saline solution frequently 
gives excellent results. If the shock is maintained 
by the presence of a mangled limb, it may be well to 
perform an amputation. 

What diseases of the tongue may be mistaken 
for carcinoma ? , 

Primary, secondary, or tertiary syphilis, leuko- 
plakia, chronic glossitis, traumatic ulcers, tubercular 
ulcers, sarcoma, and actinomycosis. 

Mention two varieties of cysts of the tongue. 
Give the treatment of one variety. 

Dermoid cyst. — Retention cyst, due to the occlu- 
sion of the duct of a small mucous gland. 

The retention cyst is best treated by excision. 

Mention the materials employed for sutures, and 
describe the twisted or hare=lip suture. 

Silk, silkworm-gut catgut, kangaroo tendon, sil- 
ver wire, and horse-hair. 

The hare-lip or twisted suture consists of metallic 
pins or needles thrust through both lips of the 
wound, the edges of which are kept in contact over 
the pins by figure-of-eight turns of silk. 

Give the etiology, clinical appearance, and the 
treatmeut of acute ranula. 



ORAL SURGERY- 8r 

Acute ranula is an accumulation of saliva (from 
obstruction and rupture of Wharton's duct) in a 
serous sac known as Fleischmann's bursa (Tillaux). 
Duplay considers the acute ranula to consist of a 
dilatation of the duct itself. 

The cystic tumor is situated in the floor of the 
mouth to one side of the median line. It is globular, 
semi-transparent, and may attain the size of a ban- 
tam's egg, pushing the tongue upwards and back- 
wards and interfering with deglutition and speech. It 
contains a glairy mucous fluid. 

Treatment. Excision of a portion of the anterior 
wall of the cyst and swabbing out the cavity with 
pure carbolic acid. The cavity is then packed with 
iodoform gauze and made to heal by granulation. If 
the condition recurs, the entire growth is to be 
excised. 

flention the varieties of displacement in fracture of 
the inferior maxilla, (live the symptom of treatment of 
one variety. 

In fractures through the angle, or lower part of 
the ramus, there is usually little displacement as the 
masseter on the outer side and the internal pterygoid 
on the inner side, maintain the fragments in apposi- 
tion. When the fracture passes through the neck of 
the condyle, that process is drawn forward and inward 
by the external pterygoid, w T hilst the body of the bone 
is freely movable antero-posteriorly, and is dis- 
placed toward the fractured side. 

When the coronoid process is detached it is 
drawn upwards by the temporal tendon, but no great 



&? ORAL SURGERY. 

displacement can occur, owing to the extensive at- 
tachment of the tendinous fibres. 

In the most common fracture, through the body 
of the bone near the mental foramen, the large an- 
terior fragment is displaced downwards by the mus- 
cles passing from the hyoid bone to the Jaw. The 
smaller fragment is drawn upwards by the muscles of 
mastication and is displaced outwards, so that it over- 
laps the anterior fragment. 

In a fracture through the bod}^ of the jaw there 
will usually be hemorrhage from the mouth, irregu- 
larity of the denture, crepitus, and a displacement as ' 
described above. The treatment consists of the re- 
duction of the displacement, the application of a Bar- 
ton bandage and the maintenance of an aseptic con- 
dition of the oral cavit3 r . If necessary, Hammond's 
splint may be applied. 

Define neurasthenia and give its symptoms and 
treatment. 

A condition of lack of power of the nerve-cen- 
tres, not dependent upon the existence of organic 
disease in any portion of trie body. 

Symptoms. — Loss of weight and slight anemia r 
excessive irritability of the heart, spots of local ten- 
derness over the spine, weariness upon exertion r 
weakness of memory, disturbance of sleep, flushes of 
heat, profuse sweating, and occasionally disturbances 
of sensation. 

Treatment. — Rest, with change of scene and diet; 
massage, out of door life, avoidance of excitement. 



ORAL SURGERY. 83 

strychnine in fnll doses, and, best of all, the " rest 
cure" as prescribed by Dr. S. Weir Mitchell. 

Define odontoma. Give the classification, clinical 
appearance, and the treatment of odontoma. 

An odontoma is a tumor originating from some 

abnormal condition of the teeth or teeth germs. 

1. Epithelial odontome. Originates from enamel 
organs, usually affects lower jaw, forms tumor of 
great size, and as a rule runs a. perfectly benign 
course. The only treatment consists in complete 
removal of the affected portion of the jaw. 

2. Follicular odontome (dentigerous cysts), 
More common in lower jaw, tumor, at first, hard and 
solid, but subsequently gives egg-shell crackling and 
even fluctuation. A permanent tooth will be found 
missing, and there is no history of its having been 
extracted. The treatment consists in excising a por- 
tion of the wall of the cyst from the mouth and ex- 
tracting the misplaced tooth. The interior of the 
cyst is then to be thoroughly scraped, flushed with 
an antiseptic solution and packed with gauze. 

3. Fibrous odontome. Occurs rarely in rickety 
children; there is thickening and condensation of the 
connective tissues around a tooth-sac. Treatment, 
thorough removal. 

4. Radicular odontome. A tumor composed of 
cement developing at the root of a tooth. It causes 
severe pain and may result in septic inflammation of 
the surrounding bone. Treatment, thorough removal. 

5. Composite odontome.— These may be very large 
and resemble osteomata of the antrum. Treatment, 



ORAL SURGERY. 

thorough removal if causing trouble. 

Give the etiology, clinical division, pathologic 
classification, and the treatment of tumors. 

Etiology. — Injury or irritation, infection, her- 
edity, fetal residues. 

Clinical Division. Benign and Malignant. 

Pathologic. Classification. 

I. Mesoblastic or Connective Tissue Tumors. 

A. Those conforming to the types of fully formed 
connective tissues ; 

i. Fibroma,. 
2* Lipoma. 

3. Chondroma. 

4. Osteoma. 

5. Myxoma. 

B. Those conforming to the types of the higher 
connective tissues : 

1. Myoma, 

2. Angeioma, 

3. Lymphangeioma,, 

4. Neuroma.. 

C. Those conforming to the types of embryonic 
connective tissue : Sarcoma. 

II. Epiblastic and hypoblastic tumors,, i. e. y 
those conforming to the type of Epithelial Tissues: 

1. Papilloma,, 

2. Adenoma, 

3. Carcinoma. 

III. Tumors composed of Epiblastic, Hypoblas- 
tic and Mesoblastic Elements,: Teratoma. 



ORAL SURGERY, 8 5 

Treatment. In Benign Tumors, removal if an- 
noying or if they show a tendency to become malig- 
nant. 

In Malignant Tumors, secondary deposits should 
be removed with the primary growths. If complete 
removal is impossible they had best be left alone. 

Give the causes and treatment of spasmodic 
respiratory failure. Laryngitis, laryngismus stridulus, 
tetanus, and hydrophobia. 

Treatment. In tetanus and hydrophobia treat- 
ment is practically useless. It consists of the admin- 
istration of chloral between, and of chloroform 
during .he attacks. 

In laryngitis and laryngismus stridulus, place 
child in hot bath. Give syrup of ipecac to produce 
vomiting and place hot compresses about the throat. 
If child cannot swallow, tickle throat with finger to 
produce emesis. 

Describe the operation of extracting molar teeth, 
riention accidents that may occur in the extraction of 
these teeth. 

First and second upper molars. The operator stands 

at right of patient, passing the left arm around the 

head, and holding the lip out of place with the fingers 

of the left hand. In using the cow-horn forceps, 

take care to thrust the points of the horn directly into 

the interspace and then carry the flat blade along the 

palatine fang as high as possible. A few rocks of 

the tooth inward and outward combined with a direct 

force in the line of its long axis will cause it to give 

way. 



86 ORAL S UR GER Y 

First and second lower molars. Position of 
operator as before. Use the cow-horn forceps for 
lower molars, and so apply them that the closnre of 
the handle forces the points into the interspace where 
they will meet. If closing the handle does not 
loosen the tooth, gently rock the forceps inward and 
ontward nntil the tooth is felt to yield, when it is at 
once to be lifted from its socket. 

In extracting the third molar, an appropriate 
forcep mnst be selected and the traction made in the 
axis of the single curved root, usually backwards and 
upwards or downwards, as the case may be. 

The accidents of extraction are : Laceration of 
gum, fracture of alveolar process, paralysis ,excessive 
hemorrhage, loosening or breaking of other teeth, and 
luxation of the inferior maxilla. 

Define replantation of teeth, transplantation of 
teeth, and implantation of teeth. 

By replantation is meant the return of a tooth to 
its natural socket after extraction. 

By transplantation is meant the transference of 
a tooth from its original socket to one existing in an- 
other jaw. 

By implantation is meant making a socket in a 
jaw where none exists and inserting a tooth into it. 

Give a differential diagnosis of traumatic ulcer of 
the tongue and epithelioma of the tongue. 

The traumatic ulcer is usually situated upon the 
side of the tongue opposite a mass of tartar, an angle 
of a tooth, or the edge of a plate. The ulcer is 



ORAL SURGERY. 



*7 



ragged, irregular, without induration (unless very 
chronic,) and the lymphatic glands beneath the lower 
jaw are not enlarged. 

Epithelioma occurs in middle aged or elderly 
individuals. The ulcer has a widely indurated base, 
thick everted edge, an irregular warty surface, a wa- 
tery discharge, and there is an enlargement of one 
or more of the submental glands. 

Give a differential diagnosis of suppuration of the 
maxillary sinus and tumor of the maxillary sinus. 



Suppuration. 

History of preceding alveolar ab- 
scess or rhinitis. 



Tumor. 



No such history. 



Exophthalmos, encroachment 
Causes same deformity, but to a upon nasal fossae, a flattening of 
less degree. roof of mouth, and a projection of 

the cheek below the malar bone. 

Intermittent discharge of pus from Nq suppuration . 
nostril of affected side. 



Fever. 



No fever 



If acute, the cheek is red, hot, and 

swollen , and the part is painful. Ma ? be P ainf ul 0r P ainless ' 



Exploratory puncture reveals pus. 



Exploratory puncture does not 
reveal pus. It may reveal blood 
(sarcoma), or exploratory puncture 
may be impossible, (osteoma.) 



Give the etiology diagnosis, and treatment of cys- 
tic dilatation of Steno's duct or of Wharton's duct. 

Etiology. — A salivary calculus may be formed 
within Steno's duct and completely occlude its lumen. 



88 ORAL SUR GER Y. 

Diagnosis: Painful swelling in region of parotid 
gland, pain increased by the ingestion of food. The 
calculus may be readily detected by probing the duct, 
or it may be felt through the tissues of the cheek. 

Treatment. — Remove the calculus by an incision 
into the overlying buccal mucous membrane. 

State how syncope spontaneously arrests hemor= 
rhage. 

By reducing the force of the blood current and 
thus permitting coagulation to occur within the 
wounded vessel. 

Describe the Hammond wire splint and state in 
what class of fractures it can be successfully employed. 

It consists of a firm wire collar or framework 
which encircles the whole series of teeth in the lower 
jaw. It is accurately fitted to the jaw and fixed by 
several wires passing from one half of the jaw to the 
other, between the teeth. 

It can be successful^ employed in a fractured 
mandible where there is much displacement. 

Define fracture. Give the local and the constitu= 
tional causes of non=union of fractures. 

A fracture is a sudden solution of continuity in 
a bone, usually due to excessive violence. The local 
causes of non-union are: 

1. Faulty apposition. 

2. The interposition of fluid, muscular or apone- 

urotic tissue, or pieces of bone between the 
ends of the fragments. 



ORAL SURGERY. 89 

3. Want of rest. 

4. Defective blood supply. 

5. Defective innervation. 

6. Inflammation on the surface of the limb. 

7. Faulty treatment, and, 

8. Local affections of bone (malignant tumors, 

destruction of the periosteum by inflamma- 
tion). 

The constitutional causes are: 

1. General constitutional weakness. 

2. Osteomalacia 

3. Scurvy. 

4. Syphilis. 

5. Senility (probably). 

6. Pregnancy, and 

7. The cancerous cachexia. 

Differentiate sapremia, septicemia and pyemia. 

Sapremia (septic intoxication) is a wound fever 
due to the absorption of the products of putrefaction 
into the system. It is a toxemia or condition due to 
chemical poisoning, and the blood is not in- 
fective. 

Septicemia (septic infection) is a wound fever due 
to the introduction into the blood and tissues of bac- 
teria which rapidly multiply. The blood is infective, 
since it not only contains the toxins but also the 
organisms which produce them. 

Pyemia is a wound fever developed during the 
process of suppuration and is due to the absorption 
of pyogenic organisms into the circulation. Clinic- 



go ORAL S UR GER Y. 

ally, pyemia is septicemia plus metastatic abscesses. 

State precautions that should be taken when ope= 
rating on syphilitic patients. 

Any cracks or abrasions upon the hands of the 
operator should be protected by a collodion dressing 
and the hands should be encased in a pair of sterile 
rubber gloves. At various intervals during the op- 
eration, the hands should be immersed in an antisep- 
tic solution and then rinsed in sterile water. At the 
conclusion of the operation the hands should be well 
scrubbed, soaked for several minutes in a bichloride 
of mercury solution (i-iooo), and then washed in ster- 
ile water. 

In trifacial neuralgia caused by infection, malaria, 
grip, what division of the nerve is usually involved ? 

The first or ophthalmic division. 

What produces mechanical asphyxia during ether 
or chloroform anesthesia ? 

Mechanical asphyxia is produced by the tongue 
falling back over the glottis. 

Give the differential diagnosis of fracture and dis= 
location. 

Fracture: Dislocation; 

Preternatural mobility. Immobility. 

Crepitus. No crepitus. 

The deformity usually returns The deformity does not usually 

immediately after it has been cor- recur after jt has beea correcte(L ' 
rected. 

Give the anatomic and the clinical varieties of 

hemorrhage. 



ORAL SURGERY. 9 i 

The anatomic varieties of hemorrhage are the 
arterial, the venous, and the capillary. 

The clinical varieties of hemorrhage are primary 
hemorrhage, intermediate or reactionary hemorrhage, 
and secondary hemorrhage. 

State why an alveolar abscess may cause suppura- 
tive inflammation of the maxillary sinus. 

Because the suppuration is in the floor of the 
sinus and may point towards its cavity or cause a 
suppurative inflammation by contiguity of structure. 

Mention the predisposing and the exciting causes, 
together with the local and the constitutional symptoms 
of inflammation. 

The predisposing causes include everything 
which lowers the general resistance of the body ; 
such as Bright's disease, diabetes, anemia, tubercu- 
losis and chronic alcoholism. 

• The exciting causes are traumatism, heat, cold, 
chemical agents, and bacteria. 

The local symptoms are redness, heat, pain, 
swelling, and modified function. The constitutional 
symptom is fever. 

Give the pathology, symptoms and treatment of 
inflammation. 

Pathology.— There are three sets of changes : 

I. Chauges in the blood vessels and in the cir- 
culation. The blood vessels dilate. The current is 
at first more rapid but soon becomes slower, so that 
an axial stream (red blood corpuscles) and a periaxial 



9 2 ORAL SURGERY* 

stream (white blood corpuscles and blood placques) 
may be differentiated. In addition to dilating, the 
vessels become elongated and tortuous. The current 
finally becomes so sluggish that it moves onward 
with each systole and backward with each diastole 
(oscillation). This is followed by stasis. 

2. Exudation of serum and transmigration of 
the leucocytes. 

3. Changes in the tissues themselves. These 
consist of a multiplication of the fixed and wandering 
connective tissue cells. 1 

Symptoms. — The local symptoms are redness, 
heat, pain, swelling, and modified function. The 
constitutional symptom is fever. 

Treatment. — The local treatment includes rest, 
elevation, the use of heat or cold, local blood-letting, 
astringents, antiseptics, counter-irritation, compres- 
sion, and massage. 

The constitutional treatment comprises good 
hygiene, a light nutritious diet, purgatives, venesec- 
tion, antipyretics, hypnotics, analgesics, stimulants 
and tonics. 

Give the cause and treatment of noisy movements 
of the temporo=maxiIlary articulation. 

Cause. — Laxity of ligaments and weakness of 
surrounding muscles. In some cases it is due to a 
displacement of the inter-articular cartilage. 

Treatment. — Tonics, electricity. The wearing 
of an occipito-mental sling. If the inter-articular 
cartilage is displaced an incision may be made into 



ORAL SURGERY. 93 

the joint and the cartilage sutured in its normal 
position. 

Define septic intoxication. Give treatment. 

Septic intoxication is a form of poisoning result- 
ing from the absorption of the products of putrefac- 
tion. 

The local treatment consists of the thorough re- 
moval of the source of infection and of the antiseptic 
treatment of the wound. 

The constitutional treatment must be of a sup- 
porting character. Alcohol and hypodermatic injec- 
tions of strychnine are to be recommended. 

Define stomatitis. Mention the varieties of sto= 
matitis and give treatment of one variety. 

By stomatitis is meant an inflammation of the 
oral mucous membrane. 

The varieties are catarrhal, aphthous, ulcerative, 
parasitic, gangrenous, mercurial, syphilitic and scor- 
butic. 

Treatment of ulcerative stomatitis: Correct the 
hygiene. Tonic doses of quinine. Touch ulcers 
with nitrate of silver. Use as a mouth wash a solu- 
tion of potassium chlorate or hydrogen peroxide. 

Differentiate acquired cleft palate and congenital 
cleft palate. 

Congenital cleft palate exists at birth and is due 
to want of union of the two palatal segments of the 
maxillary processes. 



9 4 ORAL S UR GER Y. 

Acquired cleft palate is produced at some period 
of extra-uterine life by losses of substance resulting 
from injury, syphilis, or lupus. 

How would you treat persistent bleeding after 
lancing the gums of a child ? 

By pressure with compresses soaked in peroxide 
of hydrogen ; by packing the incision with a pledget 
of cotton saturated with phenate of soda or a solution 
of tannic acid. In some cases the lips of the wound 
may be temporarily approximated by a suture. 
Monsel's salts and solutions are only to be used in 
extreme cases, since they impair the vitality of the 
tissues and increase the danger of secondary hemor- 
rhage. In addition to the local treatment, one of the 
following hemostatics may be administered : 

Tr. ergot (gtt. V, repeated in one or two hours), 
Tr. erigeron canadensis (gtt i, in water every minute 
until bleeding ceases, or until twenty doses have 
been taken), gallic acid (gr. i, every two hours). 

What treatment would you pursue in excessive 
hemorrhage after tooth extraction ? 

Remove all clots and pieces of root, plug the 
tooth-socket with a strip of gauze saturated with per- 
oxide of hydrogen, and reinforce the plug by means 
of a supporting pad. Should this fail, a plug may be 
made of gauze, the meshes of which contain tannic 
acid or alum. The advantage of the clot formed by 
tannin is that it is insoluble in the blood. Perchlorid 
of iron and Monsel's solution should not be employed 
on account of their injurious effects upon the tissues 



ORAL SURGERY. 95 

and the danger of secondary hemorrhage. In ob- 
stinate cases, the hemorrhage may always be controlled 
by packing the tooth-socket with a strip of ganze, in 
the meshes of which rapidly setting plaster-of-Paris 
has been incorporated. A pledget of cotton saturated 
with adrenalin chloride (i-iooo) may also be used. 

Give one of the causes of antral disease, its diag= 
nosis, and treatment. 

An alveolo-dental abscess discharging into the 
antrum. 

The diagnosis will be made by the presence of 
the following signs and symptoms : Pain over the 
affected region and the discovery of the offending 
tooth or root. Tenderness upon percussion of the 
antrum. The escape of pus through the nostril of the 
affected side. If the antrum contains a considerable 
quantity of pus, it will be opaque to transmitted 
light, as compared with the opposite side. The ex- 
amination is made by taking the patient into a dark 
room and introducing a small incandescent lamp into 
the mouth, which is then closed. If the pus can find 
no outlet, the floor of the orbit will be pushed up, 
causing exophthalmos, the nasal fossae will be en- 
croached upon, and there will be edema of the cheek. 

The treatment consists in the establishment of 
efficient drainage and the thorough irrigation of the 
cavity of the antrum. This may be accomplished by 
extracting the offending tooth or root and enlarging 
the opening into the antrum. The antrum may also 
be entered above the root of the second bicuspid 



p6 ORAL S UR GER Y. 

tooth, about one inch above the border of the gum. 
The opening into the antrum must be kept open by 
a gauze or tubular drain until the discharge entirely 
ceases. During this time the cavity of the antrum 
may be irrigated, — at first daily, and subsequently, 
at longer intervals. 

How would you treat a case of external fistula 
with adhesion from an alveolar abscess ? 

The entire fistulous tract must be dissected 
out and all cicatricial tissue removed. The necrotic 
bone must be burred away until healthy bone is 
reached. After the hemorrhage has been arrested 
the adjacent skin is to be loosened up and a flap slid 
over the site of the bone lesion, so that the cutaneous 
wound shall not directly overlay the wound in the 
bone. 

How would you diagnose and treat hypertrophy 
of the gums, and in what class of persons, as to age and 
mentality, does it occur? 

Diagnosis. — Diffuse, spongy bleeding overgrowth 
of gums. Teeth show that they have been greatly 
neglected and are covered with ac emulated deposits. 
The affection occurs after second dentition, usually 
between the ages of 18 and 25, in those who are 
ignorant and careless in their personal hygiene. 

Treatment. — Remove all deposits. Clean teeth. 
Give antiseptic mouth washes. Instruct in care of 
mouth, and, if necessary, leech, incise, or excise 
redundant tissue; or galvano-cautery may be used. 



ORAL S UR GER Y. 97 

How would you treat luxation of the inferior 
maxilla ? Describe the lesion and treatment anatomi= 
cally. 

The mechanism is as follows: When the mouth 
is opened the condyle slides forward upon the emi- 
nentia articularis and only a slight traumatism is 
necessary to displace it still further forward into the 
zygomatic fossa. The inter-articular cartilage may 
or may not follow the condyle. 

The luxation may be unilateral or bilateral, more 
frequently the latter. The mouth cannot be closed and 
the lower jaw projects anteriorly beyond its normal 
position. A hollow may be felt just in front of the tra- 
gus, in the position normally occupied by the condyle. 
The condyle may be felt in front of this hollow. If 
the finger is inserted into the mouth, the coronoid 
process may be felt in an abnormal position beneath 
the zygoma. If the dislocation is unilateral, the 
symptoms are less marked, the jaw is more mobile, 
and the chin is displaced towards the sound side. 

Treatment. — All that is needed is to depress the 
condyle below the level of the eminentia articularis, 
when the masseter, temporal and internal pterygoid 
muscles readily draw it back into the glenoid cavity. 
The patient is to be seated in a chair; the surgeon 
stands in front of the patient and presses downward 
upon the molar teeth with his thumbs, which are 
guarded with a towel. This pressure is continued in 
a downward and backward direction until the condyle 
clears the eminentia articularis, when the chin is 
raised by the fingers. The jaw is then to be kept at 



g8 ORAL SURGERY* 

rest for four or five days by a Barton bandage. 

Give briefly your method of procedure in the 
treatment of a compound fracture of the inferior maxilla. 

The niouth, or the external wound, is to be kept 
as aseptic as possible. Inordinary cases, an external 
moulded splint may be applied to the chin, and the 
lower jaw held against the upper one by means of a 
Barton or of a four-tailed bandage. 

The fragments may be held in place by a wire 
collar encircling all of the teeth of the lower jaw. 
This collar is to be accurately fitted, first to a cast of 
the jaw and then to the jaw itself, and fixed by sev- 
eral wires passing from one half to the other, between 
the teeth. 

If the teeth are defective, Kingle}^s splint may 
be employed. This consists of a vulcanite splint fit- 
ted over the alveolar process. Curved metal bars are 
attached to the front of the splint and extend back- 
ward over the cheeks from the angles of the mouth. 
The splint is kept in position by a bandage passing 
over the bars and under the chin. This splint will 
immobilize the fragments, even when the mouth is 
opened. 

In obstinate cases the fragments may be wired. 

Give the diagnosis and treatment of a dentig= 
erous cyst. 

Diagnosis: These cysts are usually encountered 
in young individuals, but may occur in later life. 
They are far more common in the lower than in the 
upper jaw. At first the tumor is hard and solid, but 



ORAL SURGERY. 99 

as the bone expands it becomes thinned, and palpa- 
tion reveals egg-shell crackling or even fluctuation. 
Upon examination of the denture, one of the teeth 
will be missing and there will be no history of its ex- 
traction. 

Treatment. — Excise a portion of the wall of the 
cyst (through the mouth) and extract the misplaced 
tooth. The interior of the cyst should then be 
scraped, irrigated, and packed with iodoform gauze. 

How would you diagnose and treat epulic tumors ? 

Diagnosis. — Benign or fibrous epulis appears as 
a red, fleshy mass, smooth or lobulated, elastic to the 
touch and probably showing some superficial ulcera- 
tion. It is a painless tumor of slow growth. 

Malignant or myeloid epulis forms a soft, rapidly 
growing, painful tumor, dusky red in color, and soon 
ulcerating. 

Treatment. — The best treatment for fibrous epulis 
is to remove the growth, together with that portion of 
the alveolus from which it takes its origin. If neces- 
sary, a tooth on either side of the tumor, must be 
extracted, each socket cut through vertically with 
a saw, and the incisions united below with a chisel. 
In this manner, a quadrangular piece of the alveolus 
is removed without interfering with the continuity of 
the jaw. 

In malignant epulis, it is necessary to operate as 

early as possible and to carry the bone incisions quite 

wide of the margin of the tumor. If the tumor is 
LofC. 



ioo ORAL SURGERY. 

large, it may be necessaiy to remove trie entire thick- 
ness of the lower, or the palatal segment of the 
upper jaw, as the case may be. 

What do you mean by necrosis ? Give its diag= 
nosis and treatment. 

By necrosis we mean the death of bone en 
masse. 

The diagnosis is made by the presence of a 
sinus, the history of a preceding inflammation, and 
the results obtained by probing. Dead bone feels 
rough and hard ; the probing is not painful, nor is it 
followed by bleeding. 

Treatment. — This consists in the thorough re- 
moval of the dead bone. It may be necessary to 
chisel or burr through the involucrum and extract 
the sequestrum. The cavity should be well curetted, 
irrigated, and packed with iodoform gauze to make it 
heal up from the bottom. 

What is a ranula and how would you treat it ? 

A ranula is a retention cyst, due to the obstruc- 
tion and dilatation of one of the ducts of the sublin- 
gual or submaxillary gland. 

The treatment consists in removing a good-sized 
piece of the wall of the cyst and swabbing out its 
cavity with pure carbolic acid. 

What do you know about aphthae and their treat= 
ment? 

The term " aphthae " is an old one and includes 
aphthous stomatitis, ulcerative stomatitis, thrush, and 
cancrum oris. 



ORAL SURGERY. ior 

Aphthous stomatitis. — Seen in nursing children. 
Inspection reveals numerous small round vesicles on 
the cheeks, lips, and tongue ; the vesicles soon break, 
leaving shallow ulcers with a red areola. 

Treatment. — Sterilize the milk. Correct any 
gastric disturbance. Use a mouth wash of boric 
acid. 

Ulcerative stomatitis. — Attacks children and 
adults when in poor health or subjected to bad hygi- 
enic surroundings. Inspection reveals linear ulcers 
with gray sloughing bases. The sub-maxillary 
glands are swollen. In severe cases, loosening of 
teeth and necrosis of bone may follow. 

Treatment. — Correct hygiene. Tonic doses of 
quinine. Touch ulcers with nitrate of silver. Use 
as a mouth wash a solution of potassium chlorate or 
hydrogen peroxide. 

Parasitic stomatitis (thrush). Inspection reveals 
numerous white elevations, which on removal leave 
a raw surface. Microscopic examination reveals the 
saccharomyces albicans. 

Treatment. — Correct the hygiene. Treat any 
gastric disturbance. Tonics. Some antiseptic mouth- 
wash, such as solutions of borax, boric acid, or hydro- 
gen peroxide. 

Gangrenous stomatitis (cancrum oris). — Usually 
seen in debilitated children and after one of the spe- 
cific fevers, particularly measles and whooping-cough. 
The cheek is the part affected. Externally, it is 
swollen, hard, red and glazed ; internally, an irregu- 



102 ORAL SURGERY. 

lar sloughing ulcer is noted. 

Treatment. — Good hygiene and stimulants. Chlo- 
roform the child and excise the gangrenous area, cut- 
ting widely into healthy tissue. The edges of the 
wound are then cauterized with fuming nitric acid, 
bromine, or the actual cautery. The resulting de- 
formity must be treated later by a plastic operation. 

Describe trismus and how it differs from tetanus. 

Trismus simply means a spasmodic locking of 
the jaws. It may have its cause in associated deutal 
lesions, causing irritation of the nerves of the part; it 
is also a symptom of tetanus. 

Tetanus is an acute infectious disease, due to the 
bacillus of tetanus and characterized by tonic spasms 
with clonic exacerbations. The spasms also affect 
the muscles of the trunk. 

What is a traumatic lesion ? 

A traumatic lesion is a solution of continuity 
due to injury. 

By what surgical operation would you abort an 
impending alveolar abscess ! 

Make a slight cut with a sharp scalpel through 
the soft parts at the apex of the affected tooth. Pierce 
the outer plate of bone with a spear-pointed drill, thus 
entering the region in which the suppuration is im- 
pending. This wound should be kept patulous for 
several days. 

How would you diagnose and treat empyema of 
the antrum ? 



ORAL SURGERY. ioj 

Diagnosis: — Pain over the affected region. Ten- 
derness upon percussion. The escape of pus through 
the nostril of the affected side. If the antrum con- 
tains a considerable quantity of pus, it will be opaque 
to transmitted light, as compared with the opposite 
side. This examination is made by taking the 
patient into a dark room and introducing a small in- 
candescent lamp into the mouth, which is then closed. 
If the pus can find no outlet, the floor of the orbit 
will be pushed up, causing exophthalmos, the nasal 
fossae will be encroached upon and there will be edema 
of the cheek. 

The treatment consists in the establish- 
ment of efficient drainage and in the thorough ir- 
rigation of the cavity of the antrum. This may 
be accomplished by extracting the offending 
tooth or root and enlarging the opening into the 
antrum. The antrum may also be entered above the 

root of the second bicuspid tooth, about one inch above 
the border of the gums with surgical engine so as to 
remove all shreds of tissue and diseased bone.. The 
opening into the antrum must be kept open by a 
gauze or tubular drain until the discharge entirely 
ceases. During this time the cavity of the antrum 
may be irrigated, at first, daily, and subsequently, at 
longer intervals. 

What are the indications for the use of the lance 
in deciduous dentition? 

The lance should never be used until the appear- 
ance of the white line, which is due to the pressure 
exerted by the erupting tooth. Lancing should never 



io4 ORAL S UR GER Y. 

be performed unless reflex disturbances are produced. 

What anatomical irregularity of the inferior third 
molar tooth frequently presents itself in extraction ? An= 
ticipating this condition, how would you extract it ? 

The roots of the inferior third molar are almost 
always fused and curve backward. This throws the 
tooth against the second molar. Always endeavor to 
determine the course of the root, and then make 
traction in a corresponding direction, usually up- 
wards and backwards. 

Name some of the forms of sutures emploj'ed in 
the closing of surgical wounds, and what substances are , 
used ? 

The interrupted, the continuous, the mattress, 
the quilled, and the shotted suture. 

The materials employed are silk, silkworm-gut, 
cat-gut, kangaroo tendon, and silver wire. 

What is torsion, and when is it preferable to other 
means in arresting arterial hemorrhage ? 

By torsion is meant the twisting of an artery 
until its middle and internal coats are lacerated. 

It is preferable to other means in plastic opera- 
tions, where it is not considered desirable to leave too 
many ligatures behind. It is also preferable where 
aseptic ligatures cannot be obtained. 

What is the difference between a simple and a 
compound fracture ? 

A simple fracture has no communication with 
the external air. A compound fracture communi- 
cates with the external air. 






ORAL SURGERY. 103 

When it is surgically necessary to make an inci= 
sion through a muscle and a choice exists for carrying the 
incision parallel or transverse to the fibres of the muscle, 
which way would you adopt, and why ? 

Make the incision in the direction of the fibres. 
The reason for this is that fewer fibres will be sev- 
ered and the function of the muscle will be practi- 
cally unimpaired. 

What is a sequestrum ? 

A sequestrum is a piece of dead bone resulting 
from necrosis. 

1 
At what point is the trunk of the facial nerve most 

liable to injury ? If severed, what change occurs? 

At its exit from the stylo-mastoid foramen. If 
severed, a paralysis of the muscles of expression of 
the affected side is produced. The folds and wrinkles 
are obliterated upon the paralyzed side. The eyelid 
cannot be completely closed. On attempting to laugh 
or show the teeth, the muscles of the non-paralyzed 
side alone are contracted, and marked asymmetry 
results from the drawing over of the opposite side. 
The lips cannot be closed firmly, and whistling is im- 
possible. Food collects betw r een the cheek and the 
teeth, owing to the paralysis of the buccinator muscle. 

What is hare=lip ? Describe a remedial opera- 
tion and give the best age for its performance. 

A hare-lip is a congenital fissure of the upper 
lip, which may extend for a variable distance through 
the tissues. 



106 ORAL S UR GER Y. 

Rose's Operation. The incision extends from the 
apex of the cleft, or from within the nostril in a con- 
centric manner so that a slight angular projection is 
formed to constitute a prolabium. This is done on 
each side and, where the nose is much flattened, more 
tissue is removed from the outer than from the inner 
side, so that when the parts are sutured together, the 
nostrils become as nearly as possible symmetrical. 
By this means, the depth of the lip is increased to 
allow of subsequent contraction; the vermilion bor- 
ders must be accurately approximated. Two deep 
silver-wire sutures should be introduced, one just above 
the red margin and one close to the nose. Cat-gut 
sutures are used to bring the margins of the Avound 
together accurately. The dressing consists of gauze 
and collodion. The gauze is cut in the shape of a 
paddle, the broad ends being fastened to the cheek. 
This should be so applied as to prevent tension upon 
the wound. The silver-wire sutures are removed upon 
the fourth day. 

The best age for the performance of the opera- 
tion is from 6 weeks to 3 months. 

Define ankylosis. Give an example. 

Ankylosis is a condition of partial or complete 
immobility of a joint, resulting from some preceding 
inflammation of the articular structures. As an ex- 
ample might be given that form which is seen in the 
elbow joint after fractures into the articulation, and 
the subsequent period of enforced rest. 
How are fractures classified ? 

Simple. — Not communicating with the external 
air. 



OR A L SUR GER Y 107 

Compound. — Communicating with the external 
air. 

Comminuted. — A number of small fractures. 

Complicated. — Associated with a dislocation or 
with a laceration of the main arterial or nervous 
trunk. 

Fractures are also divided into complete and in- 
complete. 

According to the line of fracture, they are called 
longitudinal, transverse, oblique, stellate, etc. 

Describe several methods for arresting hemor= 
rhage in general. 

Ligation. — Make an incision at a slight angle to 
the line of the artery. Expose the sheath. Make as 
small an opening in the sheath as possible and pass 
a ligature about, the vessel by means of an aneurysm 
needle. Tie the ligature tight enough to lacerate the 
inner and middle coats. 

Torsion.— Dissectthe end of the artery free from 
the sheath for half an inch. Seize it transversely with 
a hemostatic forceps, and then twist the free end of 
the artery by means of a second hemostatic forceps 
until the internal and middle coats are lacerated. 

Arrest capillary hemorrhage by filling the 
wound with hot water (125 F.). 

Give the etiology, clinical appearance, and the 
treatment of spongy gums. 

Etiology. — Stomatitis, systemic derangements of 
any kind from mild fevers to acute diseases, unclean- 



io8 ORAL SURGERY. 

liness, calcareous deposits around necks of teeth. 

Clinical appearance. — The gums appear swollen 
and flabby around the necks of the teeth. They have 
a peculiar spongy appearance and their margins are 
dotted and streaked Math bright red spots and lines. 
They bleed upon the slightest provocation. 

Treatment. — Removal of exciting cause, cleanli- 
ness, local blood-letting, the use of antiseptic mouth- 
washes, and systemic treatment according to condi- 
tion of general health. 

Give the etiology, pathology and treatment of 
pericemental abscesses. 

Etiology. — Infection from the root or from a 
pocket of pus (as in pyorrhea alveolaris). A deposit 
of uric acid upon the root may irritate the surround- 
ing tissues and lessen resistance to infection. 

Pathology. — The same as that of ai^ other 
abscess. 

Treatment. — Secure free drainage for pus, render 
the abscess cavity as aseptic as possible, and prescribe 
an antiseptic mouth wash. 

Give the etiology, clinical appearance, and treat= 
ment of arsenic necrosis of the alveolar process. 

Etiology. — The arsenic usually gains -access to 
the alveolus from an application made to the pulp. 

Clinical appearance. — A red tumefied area in 
the centre of which a slough is located. The process 
generally extends down into the alveolus and affects 
the septa between the teeth. 



ORAL SURGERY. io 9 

Treatment. — Removal of necrotic tissue. The 
local application of sesqni-oxide of iron has been 
highly recommended. Repeated syringings and an- 
tiseptic month washes. 

Give the method of removing a broken bur or 
nerve broach from a pulp canal. 

Drill aronnd the bnr with a fine fissnre drill ; 
iodine may be applied and the part rnsted ont ; sul- 
phuric acid may be used to remove some of the tooth 
structure, or an attempt may be made to draw out 
the bur with a barbed Donaldson's broach. 

Give the causes, pathologic conditions and the 
symptoms of traumatic dislocation. 

Causes. — The application of external violence 
and muscular force, acting alone or in combination. 

Pathologic conditions. --The ligaments are par- 
tially or completely torn. In closely fitting joints 
(particularly hinge-joints), the bony surfaces are fre- 
quently fractured. The cartilages may be bruised or 
partially detached and the neighboring muscles and 
tendons lacerated or displaced. Surrounding vessels 
and nerves are frequently injured and the area in- 
volved is always infiltrated by a considerable effusion 
of blood. 

Symptoms.— Pain, bruising and swelling of the 
soft tissues. Deformity, since the articular end of 
the bone is displaced into a new position where it 
may often be felt and sometimes seen. Restricted 
mobility of the affected joint. True crepitus is not 
present unless a fracture co-exists. 



no ORAL SURGERY. 

Give the diagnosis, prognosis, and treatment of 
moist gangrene of the pulp. 

Diagnosis.— If there is an outlet for the escape 
of the gases of decomposition, pain is not necessarily 
experienced. Ordinarily, however, the condition 
causes more or less intense pain, which is usually of 
a throbbing and heavy character. If inflammation 
has spread to the surrounding tissues, the application 
of heat may cause an increased amount of pain. A 
foul smelling odor is constantly present. 

Prognosis. --Not necessarily bad. The tooth may 
be saved in a majority of cases. 

Treatment.— Removal of all decomposed parts 
and products, disinfection of pulp canal, hermetical 
sealing of apex of the tooth, and filling of the pulp 
canal. 

Give the etiology, diagnosis, and treatment of 
acute nonpurulent marginal gingivitis. 

Etiology.— Mechanical or thermal irritants (such 
as rough edges of an overhanging filling), rough 
treatment in excavating or filling a cavity, overheat- 
ing while drying a cavity, friction while excavating 
with bur, or cutting down of fillings with sand-paper 
discs, careless use of ligatures (particularly when 
they are left upon the tooth for some time), the use 
of some strong caustics, or other drugs. 

Diagnosis.— Severe pain, usually of a throbbing 
character and other local signs of inflammation. 
The tooth is slightly loose, and protrudes somewhat 
from its socket. 



ORAL SURGERY. in 

Treatment.— Removal of cause, local blood-let- 
ting, paint parts affected with iodine. 

Give the clinical appearance and the treatment of 
syphilitic interstitial gingivitis. 

Inflammation, attended with superficial ulcera- 
tion of mucous membrane and general oozing of a 
grayish-white color. 

Treatment.— Iodides internally. Antiseptic mouth- 
washes locally. 

Describe the "direct method" of producing arti- 
cial respiration, 

In the direct method, the air is warmed and 
pumped into the lungs. The apparatus required is a 
pair of bellows, a face mask, and intubation tubes (in 
case the mask does not suffice). There should be a 
metal tube, with an opening in it, set in the rubber 
tubing, so that the operator can allow the escape of 
any excess of air blown by the bellows. If the mask 
is used a ligature should be passed through the 
tongue so that it may be readily held forward. If the 
air cannot enter the lung, intubation is to be per- 
formed, and there will be no difficulty. A respiratory 
rate of 16 to 20 a minute should be maintained. If'there 
is no apparatus for warming the air, the temperature 
of the room must be raised to at least 85 ° F. 

Give the etiology, pathology, symptoms, and treat- 
ment of hyperemia of the pulp. 

Etiology. — Irritation of bacteria, lactic acid, 



1 12 ORAL SURGERY. 

traumatism, exposure, denudation of root, and irrita- 
tion from a filling. 

Pathology. — Practically that of a beginning in- 
flammation. When cut into, it bleeds, rathei freely. 

Symptoms. — Pain, increased by percussion, or by 
the application of either hot or cold substances. 

Treatment. — Local and general sedatives. Coun- 
ter-irritation. If pulp does not respond, local blood 
letting. As a last resort the pulp may be destroyed. 

What precautionary measures should be observed 
in the ligation of arteries ? 

Asepsis, avoid wounding important surrounding 
structures, make as small an opening as possible in 
the sheath, never tie near a collateral branch (or if 
forced to do so, tie branch also), and be sure that the 
ligature damages the inner and middle coats suffici- 
ently to insure the obliteration of the vessel at that 
point. 

Give the treatment of septic wounds. 

Cleanse the wound as thoroughly as possible, 
syringe with hydrogen peroxide, and irrigate with bi- 
chloride (i-iooo). If the septic condition of the wound 
is marked, solutions of chloride of zinc should be ap- 
plied to all of its recesses. If the wound is large and 
irregular, rubber drainage tubes should be introduced 
into the most dependent positions. If the wound is 
small, gauze drainage may suffice. The best dress- 
ing is one of wet bichloride gauze. The constitu- 
tional treatment should be of a supporting character. 
Give the etiology, symptoms, and treatment of 



OR A L SURGER Y. iij 

acute periostitis of the inferior maxilla. 

Etiology. — Traumatism, extension from a conti- 
guous inflammation (such as an alveolar abscess), the 
exanthemata (particularly measles and scarlet fever) . 
It may also be caused by general conditions, such as 
rheumatism, gout, or pyemia. 

Symptoms.— The ordinary phenomena of acute 
inflammation. The pain is of an intense aching 
character, worse at night, and increased by pressure. 
If the outer surface is involved, and the process go 
on to suppuration, a brawny swelling develops which 
softens in the center, the overlying skin becoming 
reddened and edematous. When the abscess is opened, 
bare bone is felt, and the greater portion of the de- 
nuded structure dies. 

Treatment.— Rest, leeches, and fomentations lo- 
cally, if seen early. A good purge should be given, 
and any underlying diathesis treated. If suppuration 
is threatened, a free incision should be made down 
to the bone. If necrosis has occurred, the parts must 
be dressed antiseptically, until the sequestrum is de- 
tached. If the sinus opens internally, antiseptic mouth- 
washes. 

Give the etiology and treatment of epistaxis. 

Etiology.— Traumatism, ulcers or tumors of the 
nasal septum, rupture of varicose veins in mucous 
niembrame of septum, cerebral congestion, hemo- 
philia, purpura, scurvy. 

Treatment.— In the majority of cases there is a 
local cause. If the bleeding point is detected, it 
should be touched with a pointed galvano-cautery or 



ii4 ORAL SURGERY. 

with a swab saturated with a solution of chromic acid. 
Cold may be applied to the root of the nose and to 
the nape of the neck. If the bleeding point cannot 
be located, the anterior nares should be packed with 
strips of aseptic gauze saturated with hydrogen per- 
oxide. If the hemorrhage still continues and the 
blood drips into the nasopharynx, the posterior nares 
must be plugged with the aid of Bellocq's sound or 
a rubber catheter. 

Describe the necessary preparation of patients for 
general anesthesia by ether or chloroform. State what 
remedies and instruments should be at hand. 

The patient should be examined as carefully as 
though he were an applicant for life insurance, and 
all organic diseases should be excluded. This in- 
cludes physical examination of the lungs, heart, ab- 
domen, etc. and chemical and microscopical examin- 
ation of the urine. The night before the anesthesia, 
the patient should receive a half ounce of Epsom 
salts, and on the morning of the operation, the lower 
bowel should be emptied by enema. Just before the 
anesthesia all loose bodies, false teeth, etc., should 
be removed from the mouth. No food should be 
taken for at least six hours before the anesthesia. 

Instruments and remedies. --Sterile hypodermatic 
syringe and sterile solutions of atropine sulphate, 
strychnine sulphate, nitro-glycerine. Brand}', ammo- 
nia, tongue forceps, and mouth gag. Tracheotomy in 
struments, a battery, and an apparatus for forced arti- 
ficial respiration should always be within reach in a 
hospital. 



ORAL SURGERY. u 5 

Give the treatment of wounds of the tongue. 

Arrest hemorrhage by exposure to the air, ice, 
hot water or ligation. If wound is small, sutures are 
not required. If large, deep seated sutures should be 
introduced and the ends tied with more than ordinary 
care, since the motions of the tongue are apt to 
loosen the suture. An antiseptic mouth-wash should 
be prescribed. 

Define scarification. Give the method of this ope= 
ration and state the results obtained, mention the nec= 
essary precautions to be observed in scarification. 

By scarification is meant the operation of mak- 
ing numerous small superficial incisions. 

The incisions should be parallel, arranged in the 
form of a lozenge and go through the skin and 
superficial fascia. 

The results obtained are bleeding and the re- 
lief tension. 

The necessary precautions to be observed are the 
details of rigid asepsis. 

Mention three tumors of antrum. Give treat= 
ment. 

Osteoma, sarcoma, and carcinoma. 

Treatment.— The osteoma requires no treatment 

unless it presses upon important structures, or causes 
great deformity, when the offending portions of the 
tumor may be removed. Before such a partial opera- 
ation is done, however, malignancy must be absolutely 



n6 ORAL SURGERY. 

excluded. If a sarcoma or carcinoma can be thor- 
oughly removed by an excision of the superior max- 
illa, this operation is indicated. If the malignant growth 
can not be thoroughly removed, the toxins of erysipe- 
las may be injected. 

Give the local treatment of hemorrhage. 

Exposure to air, cold, hot water, position (usually 
elevation), direct presure, styptics, cauterization, acu- 
pressure, forcipressure, torsion, and ligation. 

Give treatment of injuries of the mouth caused by 
carbolic acid. 

Apply alcohol as quickly as possible to dissolve 
excess of carbolic acid. An antiseptic mouth-wash 
should then be used. 

Give the diagnosis and treatment of papiilomata 
of the gums. 

Diagnosis. — It is an innocent epithelial tumor 
consisting of a fibrous stroma which contains blood- 
vessels, lymphatics, and an epithelial covering peculiar 
to the part from which it springs. The tumors are 
generally multiple, warty-like growths, usually soft 
and seen upon the mucous membrane. The}' do not, 
as a rule, give pain, and are either smooth, rounded or 
of cauliflower shape. They are generally very vascu- 
lar and bleed quite freely. Treatmant— Immediate and 
thorough removal since they show a most pronounced 
tendency to become malignant. 

Describe the technic of ligation of arteries. 

Thoroughly asepticize the part. Make an in- 
cision over the line of the artery. It is best to make 



ORAL SURGERY. ny 

this incision at an angle of five degrees to the line of the 
vessel. Divide the structures layer by layer, avoiding 
important vessels and nerves. After dividing skin, 
superficial and deep fascia, the pulsations of the vessel 
should be sought for. When the sheath of the vessel 
is reached, it should be opened as far away from the 
vein as possible (example, open carotid sheath upon 
inner side). This opening in sheath should be just 
large enough to allow room for the aneurism needle. 
In passing the aneurism needle always go from the 
most difficult to the least difficult side, and never lift 
the artery up from its bed to a greater extent than is 
absolutely essential. Before tying the ligature, be 
sure that it controls the circulation. In tying the 
ligature exert an equal amount of force upon both 
ends. After the vessel is ligated, the cutaneous 
wound is sutured and an aseptic dressing is applied. 

Give the differential diagnosis of ozaena and em= 
pyema of the antrum. 

In ozaena, the offensive discharge proceeds from 
both nostrils, and the nasal mucous membrane is 
atrophic. The maxillary sinuses transmit light when 
the patient is in a dark room with an incandescent 
lamp in the mouth. There is an absence of any 
inflammatory symptoms in the tissues overlying the 
antrum. 

In empyema of the antrum, the discharge pro- 
ceeds from the nostrils of the affected side; the nasal 
mucous membrane upon the oppsite side may be nor- 
mal; and the diseased maxillary sinus is more opaque 



n8 ORAL SURGERY. 

to transmitted light than is the normal antrum. 
There are inflammatory symptoms in the tissues over- 
lying the antrum. The cause of the empyema (such 
as an alveolar abscess) may be found. 

Give the diagnosis and clinical appearance of mye= 
loid sarcoma. 

Myeloid sarcoma always grows from bone. It 
affects the long bones (particularly the upper end of 
humerus and tibia, lower end of femur). It most 
commonly affects individuals between 10 and 40 years 
of age, but it may occur in old age. The tumor is 
one of rather slow growth; it may pulsate, fluctuate in 
certain portions of its extent, or give rise to egg- 
shell crackling. 

Give treatment of fracture of superior maxilla. 
State the complications that may arise. 

Correct any displacement; as a rule, all the' treat- 
ment required is to keep the patient quiet and apply 
cooling lotions to the part. The patient should be 
fed through a tube if the palatal process is involved. A 
dental plate should be applied to a broken alveolus. 

The complications that may arise are severe 
hemorrhage, suppuration (empyema of antrum) and 
necrosis. 

Give the clinical appearance, the symptoms and 
treatment of necrosis caused by an impacted wisdom 
tooth. 

The gums are usually discolored, slight bleed- 
ing is common, pus exudes from numerous openings 
over affected area. Pain may or may not be present. If 
the condition is allowed to persist the general health 
is impaired. 



ORAL SURGERY. u 9 

Treatment. --Remove cause by extracting the 
malplaced tooth. ; antiseptic mouth-washes should be 
freely employed. The necrosed portions of the al- 
veolus should be freely removed. 

Give the diagnosis and treatment of fracture of 
the inferior maxilla. 

Crepitus may be obtained. The condyle is 
usually drawn forwards and inwards by the external 
pterygoid, while the body of the bone is freely mov- 
able antero-posteriorly, and is displaced toward the 
fractured side. 

Treatment.— Barton's bandage. Owing to the 
difficulty of fixing the upper fragment, it is likely 
that wiring would be the best procedure. 

(live the symptoms of trifacial neuralgia, when 
the second division is affected. 

Spasmodic attacks of pain in the teeth of the 
upper jaw, in the upper jaw itself, in the lower lid, 
in the side of the nose, and in the upper lip. 

Differentiate neuritis and neuralgia. 

By neuritis is meant the inflammation of a 
nerve. 

By neuralgia is meant severe paroxysmal pain 
along the course of a nerve, and not associated with 
demonstrable structural changes in the nerve. 

The pain of neuritis is increased by pressure ; 
the pain of neuralgia is frequently relieved by pres- 
sure. A differential diagnosis is sometimes impos- 
sible. 



i2o ORAL S UR GER Y. 

Give the etiology and clinical features of epithe= 
lioma of the lip. 

Etiology. — It is commonly stated that this tumor 
is due to the irritation produced by smoking a short 
clay pipe, which is allowed to rest on one or the other 
side of the lip near the angle. It may also originate 
opposite a projecting rough or carious tooth. 

Pathology.— The affection may be a typical ma- 
lignant ulcer, a wart-like growth subsequently be- 
coming fungous and ulcerated, or a chronic infiltration 
leading to an irregular nodular thickening. Sections 
of the growth show an abundance of " epithelial 
pearls." 

Clinical features.-- Almost always affect lower lip. 
Rarely met with in women (i in 20). Occurs past 
middle life. Submental and sub-maxillary glands 
not implicated for three or four months. Sore de- 
velops slowly. Sharp burning or lancinating pains. 
Odor often extremely offensive. 

Why should the hands be disinfected before a sur= 
gical operation ? Describe the method used. 

Because the epidermis always contains patho- 
genic bacteria. 

Furbringer's method.— Hands and forearms are 
scrubbed continuously for five minutes with soap and 
aseptic nail-brush. The nails should be thoroughly 
cleaned and trimmed short. The hands are then 
plunged into absolute alcohol for at least one 
minute, and then are plunged while wet into a hot 
sublimate solution (1-1000) and thorough!}' scrubbed 



ORAL SURGERY. 121 

with a nail-brush for at least one minute, particular 
attention being directed to the nails. 

A better method is that of Kelly :— The hands 
and forearms are cleansed as before with soap and 
water and the nails cleaned and pared. The hands 
and forearms are then immersed in a saturated solu- 
tion of potassium permanganate until they are stained a 
deep mahogany red, or almost black. They are then 
immersed in a saturated solution of oxalic acid until 
they are completely decolorized. The oxalic acid is 
then washed off in sterile water. 

Describe the methods used in plastic surgery. 

Displacement.— Stretching or sliding of tissues. 

1. Simple approximation after freshening the edges. 

2. Sliding into position after transferring tension to 
adjoining localities. 

Interpolation— Borrowing material from adjacent 
regions, from a limb or from another person. 1. Trans- 
ferring a flap with a pedicle. 2. Transplanting with- 
out a pedicle. 

Retrenchment.— Removing redundant material 
and causing cicatricial contraction. 

Describe local anesthesia. State the precaution 
necessary in producing it. 

Local anesthesia is best effected by the use of 
cocaine, and may be employed with safety when the 
cocaine can be confined to a limited area. The part, 
say a finger, is asepticized and a stout ligature or 
fillet placed about its base. The cocaine is then in- 
jected between the layers of the skin and also in the 



J 22 ORAL S UR GBR Y. 

vicinity of the digital nerves. The entire finger will 
be anesthetized within three or five minutes. 

Precautions —Asepsis—Never risk the absorption 
of. an amount of cocaine which exceeds the normal 
dose At the conclusion of the operation, loosen the 
ligature and then tighten it again after five or ten 
seconds. Repeat at intervals so that the cocaine in 
the tissues will not all be absorbed at one time. 

Give the clinical appearance of squamous lesions 
of syphilis in the mouth. 

The epithelium is whitish and opaline resembling 

a surface that has been touched by nitrate of silver. 

If eroded, the surface is red and smooth after the 

superficial epithelium has desquamated. The patch 

is always circular or regularly oval and the derma is 

thickened upon its surface. 

Give the treatment of localized stomatitis. 

Antiseptic mouth-washes, swabbing with a weak 
solution of nitrate of silver, the removal of any local 
irritant (such as a carious tooth), and the adminis- 
tration of tonics. 

Give a differential diagnosis of an abscess, a cyst, 
and a fatty tumor. 

An abscess is characterized by redness, heat, 
pain, swelling, fever, fluctuation, pointing, and the 
hypodermatic needle reveals pus. 

A cyst is characterized by an absence of inflam- 
matory symptoms, unless it is inflamed. Fluctua- 
tion is present and the hypodermatic needle reveals 
a non-purulent fluid. A superficial cyst can be better 
outlined than is the case with an abscess. 



ORAL SURGERY. 123 

A fatty tumor is inelastic and doughy to the 
touch. It is adherent to the skin and, when it is 
moved, causes a dimpling of the overlying integu- 
ment. There is an absence of inflammatory symp- 
toms. 

State a method of sterilizing sponges. 

The sponges should be placed in a muslin bag 
and well pounded to remove all particles of sand and 
other foreign materials. They are then rinsed out 
m water several times. A very good way is to place 
them in a basin, or pail, and allow the water to run 
in upon them from a tap for several hours. They are 
next soaked in a saturated solution of permanganate 
of potassium, are afterwards decolorized in a solution 
of j oxalic or of sulphuric acid, and are then left for 
twenty-four hours in an aqueous solution of hydro- 
chloric acid, made strong enough to taste slightly 
sour. After this, they are again soaked in water un- 
til the washings are clear. They are next placed in 
a bichloride solution (1-500) for twelve hours, and 
finally are rinsed in warm water and preserved in cov- 
ered glass jars containing a three per cent aqueous 
solution of carbolic acid, the solution being changed 
every week. 

What class of patients should not be anesthetized 
by (a )nitroiis oxide, (b ) chloroform, (c) ether? 

(a) Those with diseased blood vessels. Those in 
whom complete muscular relaxation is desired. 

(b) Those with myocardial disease. 

(c) Those with bronchitis or Bright's disease. 



124 ORAL SURGERY. 

Give reason for removing a blood clot from the 
surface of a wound. 

The chief reason for removing a clot is that it is 
capable of forming a most excellent culture medium 
for the growth of bacteria. Its presence consequently 
favors the development of sepsis. If the clot is not 
removed by the surgeon, it will be removed by nature, 
since it is nothing more nor less than a foreign body. 

Give the etiology and treatment of erosion. 

Etiology. — Acids attacking the necks of the 
teeth. The acid may proceed from the buccal glands 
or be regurgitated from the stomach. 

Treatment. — Applications of milk of magnesia, 
chalk, or some such alkaline substance. Correct any 
digestive defect and destroy the glands by the cau- 
tery, if they can be definitely located. The eroded 
places should be filled. 

Give the method of operation for exposing the in- 
ferior dental nerve. 

Incision, two inches in length, along the lower bor- 
der of the jaw, beginning slightly behind the angle and 
well under the border. The upper edge of the wound is 
displaced upward over the ramus, the masseter muscle 
is separated from the bone with .a periosteal elevator, 
and a ^ inch trephine applied one inch and a quar- 
ter above the angle. This exposes the nerve at its 
entrance into the inferior dental foramen. The nerve 
may be brought to the surface b} T a small hook or, 
the incision may be prolonged above and parallel to 
the edge of the jaw and the canal for the nerve laid 
open all the way to the mental foramen. 



ORAL SURGE R Y. 125 

What dangers may result from punctured 
wounds ? Give treatment. 

The greatest danger is sepsis. Another is te- 
tanus. A lesser danger is injury of deep structures. 

Treatment. — Secure efficient drainage and pack 
the wound so as to make it heal up from the bottom. 
Infection with tetanus should be guarded against by 
opening up all parts of the wound so that the oxygen 
of the air may gain free access. 
Describe Barton's bandage. 

The roller should be two inches in width and 
six yards in length. The initial extremity of the 
roller is placed on the head just behind the mastoid 
process. The bandage is then carried under the oc- 
cipital protuberance, obliquely upward, under and in 
front of the parietal eminence, across the vertex of 
the skull, then downward over the zygomatic arch, 
under the chin, thence upward over the opposite 
zygomatic arch and over the top of the head, crossing 
the first turn as nearly as possible in the median line, 
and thence carrying the turns of the roller under the 
parietal eminence to the point of commencement. 
The bandage is then passed obliquely around under 
the occipital protuberance and forward under the 
ear to the front of the chin, thence back to the point 
from which the roller started. These figure of 
eight turns over the head and the circular turns from 
the occiput to the chin should be repeated, each turn 
exactly overlapping the preceding one until the band- 
age is exhausted. 

Differentiate an ulcer and a fistula. 



126 ORAL SURGERY. 

An ulcer is a?* solution of continuity of the skin 
or mucous membrane due to molecular death of the 
part. , ,;■ 

A fistula is a suppurating tract connecting a 
cutaneous or mucous surface with a normal cavity of 
the body, or connecting two normal cavities. Strictly 
speaking a fistula always has two openings. 

Give the (Jiganosis of ulcerating gumma of the 
oral cavity. r 

Preceding history, of ..syphilitic infection' and the 
presence of an inflammatory swelling, the surface of 
which is ulcerated. The ulcer is deeply excavated, 
the edge is undermined, the surrpiinding tissues are 
hyperemic, and there is a tough ( or soft tenacious 
slouefh adherent to its base. There is no glandular 
involvement, as a rule ; the sore will heal under spe- 
cific treatment and leave a depressed scar or a per- 
foration. .., 

Give the differential diagnosis between malignant 
and non=nialignant tumors of the upper jaw. 

Malignant tumors grow rapidly, give metastasis, 
are painful, recur after, removal, may ulcerate, and 
finally cause death. .,, :, u ., , 

Non-malignant tumors, grow slowly, do not give 
metastasis^are not painful; (except, by pressure), do 
not recur after removal, rarely ulcerate, and -do, not 
cause^ death (except mechanically). The malignant 
tumors of the upper jaw are of t more: frequent occur- 
rence than are. the benign. »• \ cr" 

Give direction for diagnosis of mercurial sto= 
matitis. 



ORAL SURGERY. 127 

The diagnosis is made by observing the follow- 
ing points : The individual may work in mercury 
or have been taking the drug internally. There will 
be tenderness of the gums, manifested by bringing 
the teeth forcibly together, redness of the gums near 
the insertion of the teeth, a metallic taste, profuse 
salivation, fetor of breath, the tongue may be red- 
dened, swollen, and ulcerated, and protrude from the 
mouth. In severe cases, ulceration of the mucous 
membrane, loss of teeth, and necrosis of the jaw 
may result. 

Describe a four=tailed bandage. 

This bandage is prepared by taking a portion of a 
roller bandage,three inches wide and one yard in 
length, and splitting each extremity up to within two 
inches of the centre. The undivided portion of the 
bandage is placed upon the point of the chin. The 
two lower tails are then drawn up and tied over the 
vortex while the two upper tails are secured behind 
the occiput and then, to prevent slipping, these ends 
are knotted to the ends of the former. 

What precaution should be taken in extracting 
molars and bicuspids of the inferior maxilla ? 

The usual antiseptic precautions, such as sterili- 
zation of instruments, and cleansing of parts by 
germicidal solutions. The selection of a proper 
forcep, the history as to previous extraction, whether 
difficult or a tendency to hemophilia, and above all, 
keep in mind the fact that fracture may occur either 
in the body or in the alveolar process if violence is 



128 ORAL S UR GER Y. 

used. The jaw may also be dislocated. The proper 
motion for loosening root attachments should be ap- 
plied and some guard placed over the upper teeth to 
prevent breaking them. Be prepared to treat shock 
and hemorrhage. 

Give the pathology and treatment of epithelioma. 

Pathology. — Squamous epithelioma are nodular 
or wart-like elevations of the skin or mucous mem- 
branes tending to superficial ulceration. The 
microscope reveals branching columns of epithelial 
cells extending from the papillae of the skin into the 
deeper structures. "Cell-nests" are frequent. In-' 
volvement of the lymphatic glands is less marked 
than in the remaining forms of carcinoma. 

Cylindric epithelioma. — Found in gastrointesti- 
nal tract and in uterus. They are composed of 
acinus-like tubular structures, frequently composed 
of a number of layers of epithelium, the outer layer 
often being distinctly columnar. Later on, the acini 
become filled with epithelial cells of various shapes 
and the cylindric character is lost. They more 
nearly resemble the glandular cancers in their general 
characteristics than does the squamous variety. 

Treatment. — Thorough excision of the involved 
tissue wherever found. If a squamous epithelioma is 
local beyond doubt, and there be no lymphatic in- 
volvement (as in xodent ulcer), the growth may be 
destroyed by Michel's or Bougard's paste. 

Describe palliative treatment of malignant tumors 
of the mouth. 



ORAL S UR GER F. i2 9 

The palliative treatment of malignant tumors of 
the mouth consists in keeping the buccal cavity as 
aseptic as possible by means of antiseptic mouth- 
washes. Local anesthetics (cocaine, menthol) are 
employed. Morphine is administered and, in some 
cases, it has been advised to divide the lingual nerve. 
If the case is one of sarcoma, Coley's fluid may be 
tried. The X-ray is a recent addition. 

Give the treatment of a case of non-union in frac= 
ture of the inferior maxilla. 

Make incision along lower border of body of jaw, 
expose fragments, remove any intervening tissue, 
freshen edges, and wire together. In some cases it 
may suffice to rub the ends of the fragments together 
and then apply a Hammond splint. 

Give treatment of a lacerated wound. 

If the wound can be thoroughly cleansed and 
the edges have not been markedly contused, such a 
wound should be sutured and a wet bichloride dress- 
ing applied. If the wound cannot be thoroughly 
cleansed or if the edges are contused, clean the 
wound as thoroughly as possible, irrigate with a bi- 
chloride solution (1-2000), and apply warm antiseptic 
fomentations until all sloughs have separated. The 
wound should then be treated like any granulating 
surface. 

What is arthritis ? Give treatment. 

By arthritis is meant an inflammation of a joint 
which involves all the structures of which it is com- 
posed. 



i jo ORAL SURGERY. 

Treatment of Acute Arthritis. —In early stage, 

elevate the limb, immobilize absolutely, and put in 

such position that, if ankylosis occurs, the part will 

be of some use to the patient. Fomentations or an 

ice-bag may also be applied. As soon as symptoms 

of approaching suppuration appear, open joint freely 

in one (or better two) places, and wash out with some 

sterile or antiseptic solution (normal saline solution 

or sublimate 1-8000). Maintain fixation, continue 

irrigation until all symptoms of inflammation have 

disappeared, and look after the general health, If 

ankylosis occurs in a faulty position, resection of 

the joint may be required. 

How would you arrest hemorrhage from the 
tongue ? 

Hemorrhage from the tongue may be arrested 
by exposure to the air, by ice, by hot water, by liga- 
tion, by suture, and by the cautery. 

Give the differential diagnosis between fracture of 
the neck of the inferior maxilla and dislocation of the 
temporo=maxillary articulation. 

In the fracture of the neck of the condyle, there 
may be crepitus, the condyle is drawn forwards and 
and inwards by the external pterygoid muscle, the 
body of the bone is freely movable, and the chin is 
displaced toward the fractured side. 

In a unilateral dislocation there is limited mo- 
tion of the jaw, no crepitus, and the chin is displaced 
toward the sound side. If the dislocation be bilateral, 
the mouth cannot be closed, the lower jaw projects 
forward, and there is a hollow upon both sides in 
front of the tragus. 



ORAL S UR GER Y. iji 

Give etiology and treatment of false ankylosis. 

Etiology. — Inflammation outside of the joint, 
disuse. 

Treatment. — Where inflammation has been 
cured, massage and passive motion, the alternate hot 
and cold douche, and graduated exercise. If due to 
disuse,, exercise, massage and galvanism. 

Define neuritis. Give cause and treatment. 

By neuritis is meant the inflammation of a nerve. 

Causes. — Inflammation, exposure to cold, some 
abnormal condition of the blood induced by rheuma- 
tism, chronic alcholism, diabetes, etc. 

Treatment. — Keep part at rest. Apply blisters 
along the course of the nerve. The administration of 
small doses of bichloride of mercury is sometimes of 
benefit. Treat anv local cause or constitutional 
dyscrasia. It may be necessary to control pain by 
hypodermatic injections of morphine. 

When should a sequestrum be removed ? 

A sequestrum should be removed as soon as it has 
separated. If the sequestrum is central (as in inferior 
maxilla), it should be left until the involucrum becomes 
sufficiently strong, the case meanwhile receiving ap- 
propriate antiseptic treatment. In such an instance, 
etc., the sequestrum acts as a splint. 

Define asphyxia. Give treatment. 

Asphyxia is suffocation. The suspension of 
vital phenomena which results when the lungs are 
deprived of oxygen. 

Treatment. — Remove any local cause. If im- 



132 ORAL S UR GER Y. 

possible to remove cause (in the larnyx for example) y 
quickly perform tracheotomy below obstruction. After 
obstruction is removed or circumvented, artificial 
respiration is always indicated. If no local obstruc- 
tion, artificial respiration from beginning; strychnine, 
atropine or probably cocaine should be given by an 
assistant while the operator is performing artificial 
respiration. 

How should chloroform be administered ? Ether? 
What accidents may occur ? Give treatment. 

Chloroform should be administered in free admix- 
ture with air (chloroform vapor 5%, air 95%). 

Ether should also be administered by the open 
method (ether vapor 95%, air 5%). 

Accidents. — Death from cardiac or respiratory 
paralysis, mechanical asphyxia, congestion of brain, 
or by the entrance of vomited material into the larnyx. 

Treatment. — Failure of respiration is treated by 
withdrawal of anesthetic, clearing out throat and 
pulling f 01 ward of tongue, the performance of artificial 
respiration, the exhibition of pungent aromatics (ammo- 
nia), the hypodermatic injection of strychnine, atro- 
pine, or cocaine, the alternate douche of hot and cold 
water, and the use of the ^electric brush." 

Failure of circulation. — Withdraw the anesthe- 
tic, invert the patient, give hypodermatic injections of 
whiskey and strychnine, and perform artificial respi- 
ration, clearing out the mouth and holding the tongue 
forward. 

Describe the operation for removing calculi from 
the salivary duct. 

The calculus is located by means of a probe and 
the palpating finger; the duct is incised and the cal- 



ORAL SURGERY- jjj 

cuius removed. If the calculus is situated in the sub- 
stance of the submaxillary gland, total removal of the 
gland may be necessary. In some cases the calculus 
may be seen projecting from the main duct of a 
gland, in which case it may be removed without in- 
cision. 

How are the wounds of arteries classified ? 

Incised, lacerated, contused, punctured, poisoned, 
and gun-shot. 

They are sometimes divided into those in which 
the artery is completely divided and into those in 
which the artery is only partially divided. 

What is the difference between a traumatic and a 
congenital dislocation ? 

A traumatic dislocation is one produced by the 
application of external violence and muscular force, 
acting alone or in combination. 

A congenital dislocation is a malformation of a 
joint which exists at birth. 

Describe Gibson's bandage. 

The roller should be two inches in width and six 
yards in length. The initial extremity of the roller 
should be placed upon the vertex of the skull in a 
line with the anterior portion of the ear; the bandage 
is then carried downward in front of the ear to the 
chin, passed under the chin, and carried upward on 
the same line until it reaches the point of starting. 
The same turns are repeated until three complete 
turns have been made. The bandage is then con- 
tinued until it reaches a point just above the ear, 



ij4 ORAL SURGERY- 

where it is reversed, .carried backward around the oc- 
ciput, and continued around the head and forehead 
until it reaches its point of origin; these circular 
turns are continued until three .turns have been made. 
When the bandage reaches the occiput, having com- 
pleted the third turn, it is allowed to drop down to 
the base of the skull, and it is then carried forward 
below the ear and.across the chin, being brought back 
upon the opposite side of the head and neck to the 
point of origin; these turns are repeated until three 
complete turns have beeir made, and upon the com- 
pletion of the third turn, y the bandage is reversed and 
carried forward over the occiput and vertex to the 
forehead, and its extremity is here secured with a pin. 
Pins should also be applied at the points where the 
turns" of the bandage cross each other. ... , 

Give the etiology and the treatment of tetanus. 

Etiology. — The infection of a wound with the 
bacillus tetani. 'It -is more common in hot climates, 
in dark-skinned races, and in those who are employed 
about stables. Hygienic 'errors favor development, 
particularly, the .overcrowding of sick and wounded 
in a limited space. ..': n .« .■ '1 . j.< , •. 

Treatment. — Preventive treatment consists of ap- 
plying the principles of antisepsis, to every wound en- 
countered. M ■--* Gj 
|v Local treatment. — Antiseptic treatment of wound. 

Symptomatic treatment. — Chloroform during 
the exacerbations of the spasm and chloral between 
the exacerbations. The introduction of food into the 
stomach by stomach tube, and the evacuation of the 



ORAL SURGERY. 



T 35 



rectum and bladder at regular intervals. Calabar bean 
has been highly recommended. 

Specific treatment. — The administration of the 
anti-toxin, which is best done by trephining and in- 
troducing it beneath the dura mater. The results ob- 
tained in man are anything but promising. 

What is pyorrhea alveolaris ? Give the etiology 
and treatment. 

Pyorrhea alveolaris is an inflammatory condition 
of the margins of the gums, accompanied by a muco- 
purulent discharge, which arises from pockets or 
pouches extending for a greater or less distance along 
the roots of the teeth. 

Etiology. — Gout, uric acid, diabetes, certain con- 
ditions of diet and irregularities of the teeth might 
be mentioned as predisposing factors. It is always 
preceded by an excessive deposit of tartar, beneath 
which bacterial infection occurs. 

Treatment. — Removal of tartar and application 
of astringents and antiseptics, preferably peroxide 
of hydrogen. These applications must be made to all 
parts of the pouches or pockets. Sulphuric acid 
has been recently recommended. The treatment is 
prolonged and tedious. In many cases the teeth have 
been sacrificed. 

Define a cyst Hention three divisions of cysts 
and give the etiology and treatment of one division. 

By a cyst is meant a more or less rounded cavity 
with a distinct lining membrane, distended with some 
fluid or semi-solid material. 

I. Cysts formed by the distension of pre-exist- 
ing spaces. 



ij6 ORAL SURGERY. 

2. Cysts of embryonic origin. 

3. Cysts of new formation. 

Etiology. — Dermoids may be due to the persis- 
tence of epithelial cells, in the deeper tissues, in situ- 
ations where fleshly segments coalesce during fetal 
life. They may also be due to the persistence of cer- 
tain tubular canals (thyro-glossal duct, post-anal 

gUt) ' 

Cysts of embryonic origin (dermoids) are to be 

removed by careful dissection. 

What are aseptic wounds ? Describe an aseptic 
wound. 

Aseptic wounds include all which are preserved 
from contamination by poisonous bacterial products, 
whether such poison come in contact with the wound 
directly or be generated in it by the action of germs 
that gain access to it. 

In an aseptic wound the process of healing is un- 
disturbed, union occurs by first intention, there is no 
suppuration and no visible sign of inflammation. 
Give treatment of an acquired cleft palate. 

If the aperture is small, the local disease cured, 
and the general health good, an attempt may be made 
to close the perforation by stripping up muco-perios- 
teal flaps, paring the edges and suturing them to- 
gether. In the great majority of cases, however, the 
best treatment consists of the introduction of an ap- 
propriate obturator or artificial velum. 

How should a penetrating wound of the temporo= 
maxillary articulation be treated ? 

If the wound is small and there is reason to be- 



ORAL SURGERY. i 3 y 

lieve that it was made by an aseptic instrument, the 
skin should be thoroughly cleansed and an antiseptic 
dressing applied. A careful watch is then kept upon 
the condition of the joint and the temperature of the 
patient; as soon as signs of acute arthritis manifest 
themselves, free incisions are to be made into the 
joint, so as to relieve tension and allow of irrigation. 
If the wound was inflicted by a dirty instrument, 
the wound should be enlarged, if necessary, so that its 
depths may be carefully examined and thoroughly 
cleansed. The cavity should be irrigated and drain- 
age inserted. . If acute arthritis supervenes, it must 
be treated in the usual way. 

Where are salivary calculi most frequently found ?t 
Give treatment. 

Salivary calculi are most frequently found in 
the duct of Wharton. 

Treatment. — If protruding from orifice of the 
duct, they may simply be extracted. If within the 
duct, they should be cut down upon and removed. 

How should a salivary fistula be treated ? 

This affection practically always occurs in rela- 
tion to Stenson's duct. If the buccal portion is in- 
volved, the duct may be slit up from within the mouth. 
If the masseteric portion is wounded, a fine probe 
should be passed into the duct (from the mouth) as 
far as the fistulous opening, and then brought out at 
this orifice. A double thread of silk is now tied to 
the end of the probe and drawn through the thickness 
of the cheek, along the buccal portion of the duct, and 



ij8 ORAL SURGERY. 

out of the external wound. A fine drainage tube is 
then carried along the same tract, and left to project 
both externally and internally. A silk thread is at- 
tached to each end of the tube and knotted around 
the angle of the mouth. In this manner a passage 
is re-established into the mouth, and as soon as it be- 
comes easier for the saliva to travel along this than 
through the external wound, the fistula will close. 
The outer half of the tube may be removed in a few 
days, and only a thread allowed to remain in the ex- 
ternal wound, which gradually contracts so that more 
and more of the saliva finds its way to the mouth. 
The silk thread and tube are finally removed, and, if 
the canal remains patent, the external wound soon 
heals. If the buccal portion of duct is obliterated so 
that the probe cannot be introduced, the thread and 
tube may be passed through all of the tissues of the 
cheek by means of a trocar and canal. The subse- 
quent steps are similar to those of the previous 
method. 

How should hemorrhage from the gums be 
treated ? 

By means of hot water, cold, compression, perox- 
ide of hydrogen, styptics, suprarenal extract, or the 
actual cautery. If due to scurvy, appropriate antiscor- 
butic treatment; if due to hemophilia, calcium chlor- 
ide gr. xxx t. i. d. and apply fibrin ferment, supra- 
renal extract, or cocaine, locally. 

Define necrosis and give treatment. 

By necrosis is meant the death of bone en masse. 



ORAL SURGERY. i 39 

Treatment- — Early in necrosis, endeavor to mod- 
erate inflammation upon which the affection depends 
and open any abscesses that may form. During the 
time occupied by the loosening of the dead bone, no 
operative treatment should be instituted, as a rule, 
but attention should be given to the general health. 
As soon as the necrosed portion has become detached, 
it should be removed. 

Give the diagnosis and treatment of tetanus. 

Diagnosis. — Trismus, opisthotonus, emprostho- 
tonus, or pleurosthotonus. The spasms are tonic in 
character with clonic exacerbations. Constipation 
and retention of urine are present. The mind is clear, 
there is a hypersecretion of sweat, and little or no 
fever. It may be possible to discover the source of 
infection. 

Treatment. — Symptomatic treatment. Chloro- 
form during the exacerbations of the spasm and 
chloral between the exacerbations. Feeding at regu- 
lar intervals (stomach tube, under chloroform), and 
the periodic evacuations of the bladder by catheter and 
the rectum by enema. Calabar bean has been highly 
recommended. 

Specific treatment. — Trephining and introduc- 
tion of anti-toxin beneath the dura. 

Local treatment. — Antiseptic treatment of 
wound. 

What is a dislocation ? Name the varieties, and 
give the causes. 

A dislocation is a displacement of one or more 



140 ORAL SURGERY. 

bones of a joint from its natural position. It is also 
the displacement of any organ from its natural posi- 
tion. 

Traumatic. — Due to violence or muscular action. 

Pathologic. — Due to disease. 

Congenital.- — Due to an error of development as 
a result of which a normal location of the bony con- 
stituents has never been present. (The term con- 
genital "dislocation" is really a misnomer — it is a 
congenital malformation.) 

What is an incised wound ? Give the prognosis 
and treatment. 

An incised wound is one made by any sharp cut- 
ting instrument. 

Prognosis. — Nearly always favorable, but de- 
pends upon the region involved and asepsis of the 
wound. 

Treatment. — Arrest hemorrhage. Render the 
wound as aseptic as possible. Unite the edges of the 
wound by means of sutures and apply a (Septic 
dressing. 

Give diagnosis and treatment of caries. 

The symptoms of caries are those of osteitis com- 
plicated by an abscess leading to the softened bone. 
When caries is primary, it particularly involves the 
cancellous tissue (ends of long bones, flat bones) . The 
pus from carious bone contains an excess of phos- 
phate of lime. 

Treatment. — If syphilitic, give potassium iodide; 
if tubercular, cod-liver oil with iodide of iron. Secure 



*> 



ORAL SURGERY. 141 

best hygienic surroundings. In early stages while the 
disease is advancing, keep the parts clean and free 
from irritation. When acute symptoms have sub- 
sided, an attempt may be made to remove the diseased 
bone by applications of iodine or of the mineral acids. 
If the carious bone can be reached from the surface, it 
may be removed with a gouge or with a burr-head 
drill. If the disease is extensive, excision may be 
required. In some cases amputation is necessary to 
prevent fatal exhaustion. 

How may general infection be caused by oral 
operations ? 

The wound in the buccal cavity may become in- 
fected by any of the micro-organisms found within 
the mouth. From this local source, the bacteria, their 
products, or both, may pass into the general circula- 
tion. 

Give the symptoms and treatment of acute sup= 
purative periostitis. 

If the bone is superficial, there will be all of the 
symptoms and signs of inflammation. If the bone 
is deep, redness, swelling, and heat may not be ob- 
served over the inflamed area, on account of the 
density of the periosteum. The pain is of a most 
intense, aching character, worse at night, and greatly 
increased by pressure or by a dependent position of the 
part. If swelling is present, it is brawny in charac- 
ter and subsequently becomes red, edematous and 
softened in the centre. If the abscess has opened 
spontaneously or has been incised, bare bone is ex- 
posed, the greater portion of which usually dies. 



142 ORAL SURGERY. 

This dead bone is either absorbed (if very small in 
amonnt) or cast off as a sequestrum. 

Treatment. — A free aseptic incision down to the 
bone at the earliest possible moment. Antiseptic 
dressing. If necrosis has occurred, it must receive 
appropriate treatment. Supporting or antidiathetic 
treatment constitutionally. 

Give the differential diagnosis between syphilitic 
and aphthous ulceration. 

Syphilitic ulcers occur in the shape of cracks or 
fissures upon the sides or tip of the tongue, or upon 
the cheeks and lips. They are common in the 
secondary period of the disease. Papular eruptions 
of the skin and mucous patches may also be ob- 
served. These ulcers respond to anti-syphilitic treat- 
ment. 

Aphthae commence as small blisters, which run 
a rapid course and are accompanied by slight saliva- 
tion, The ulcers are superficial, sharply outlined, 
multiple, and are situated not only upon the tongue, 
but particulary upon the cheeks and lips. 

Give the etiology and symptoms of the congenital 
malformation known as cleft palate. 

Etiology.— Failure of the palatal processes to 
unite. 

Symptoms. --Inspection reveals a cleft in the 
median line. If the palatal process of one side has 
united with the ethmo-vomerine septum, a cleft 
slightly to one side (usually to the left) of the me- 
dian line is observed. Since the union of the pala- 



ORAL SURGERY. 



H3 



tal processes takes place from before backward, it is 
rare to have a cleft of the anterior portion of the 
palate without the posterior portion being also in- 
volved. As a rule, there is considerable impairment 
of nutrition, from interference with deglutition. The 
exposure of the nasal mucous membrane leads to 
the formation of scabs which undergo putrefactive 
changes, producing a condition somewhat resembling 
ozaena. When the child learns to talk, articulation 
is frequently so indistinct that it is difficult to un- 
derstand, and the voice has a peculiar and charac- 
teristic intonation. The so-called explosives (whether 
dentals, labials, or gutturals) which require a certain 
amount of air-pressure within the mouth for their 
proper pronunciation, are difficult to produce. This 
is particularly to be observed in the letters b, d, p, 
t, g and f. 

Give the diagnosis and treatment of trismus 
caused by impacted third molar. 

Diagnosis.— There is a partial or complete in- 
ability to open the jaws. Inspection reveals the 
impaction of the third molar. Necrosis may be 
present. 

Treatment.— Relief of the impaction, either by 
extraction of the offending tooth or of the second 
molar. If necrosis is present, it must be treated 
upon general principles. 

Mention the most reliable agent for the de- 
struction of micro=organisms. How should it be used ? 

Heat.— It may . be used in the form of dry heat 
or moist heat (steam, under pressure if necessary, 



144- ORAL S UR GER Y. 

hot water), It should penetrate to the centre of the 
material to be sterilized. 

What diseases of the tongue may be caused by 
diseased teeth ? 

Traumatic ulceration, glossitis, abscess, and 
epithelioma. 

Describe the preparation of the oral cavity for an 
aseptic operation. 

Asepsis, as applied to the oral cavity, is but a 
relative term. All cavities in the teeth should 'be 
cleansed, disinfected and filled. The interstices be- 
tween the teeth must be carefully cleansed and 
the mouth repeatedly washed out by a boric acid 
solution as hot as can be borne. The nasal cavity 
should also be rendered as aseptic as possible, and 
the patient should gargle repeatedly with hot boric 
acid solutions. 

Define a multilocular cyst. 

A multilocular cyst is one which is composed 
of a number of loculi or chambers. 

Describe treatment and appliance for acquired cleft 
palate. 

Acquired perforations of the palate are usually 
due to syphilis, but lupus and traumatism are also 
occasional causes. Treatment should first be directed 
to the underlying cause. When inflammatory symp- 
toms have subsided and nature has done all she can 
to repair the defect, the local treatment is indicated. 
If the perforation is small, an attempt maybe made 
to close it by freshening the edges of the perfora- 



ORAL SURGER Y. i 45 

tion, dissecting up tnuco-periosteal flaps and sutur- 
ing them together. This will rarely be appreciable, 
however, and in the great majority of cases an ob- 
turator or an artificial vellum must be introduced. 

An obturator is a plate which is so adjusted as 
to close the perforation. It should never be made in 
the form of a plug, since the opening may be en- 
larged by the constant pressure and irritation. It is 
made of thin vulcanite or gold, and is fixed to the teeth 
and held in position by suction. Intra-nasal pro- 
jection will sometimes improve the quality of the 
articulation by diminishing the size of the nasal 
cavity. 

An artificial vellum is a plate obturator, to the 
posterior portion of which a hinged segment is at- 
tached, to take the place of the normal vellum. This 
hinged segment may rest upon the natal side of the 
soft palate. A thin rubber bag, filled with air and 
sewn to the posterior portion of the obturator, is 
sometimes used in place of the hinged segment. Arti- 
ficial vella are by no means so satisfactory, as a rule, 
as are the plate obturators. 

Define odontalgia. Give the etiology and treat= 
ment of odontalgia. 

Toothache. 

It may be caused by many different pathologic 
conditions of the tooth or surrounding tissues, such 
as congestion of the pulp, exostosis of the roots, pulp 
nodules, mechanical or chemical irritation, reflected 
pains from irritation of areas supplied by other 



146 ORAL SURGERY. 

branches of the fifth nerve (impacted body in exter- 
nal anditory meatus, etc.), infection, mal-occlusion, 
exposure of dentine and denudation of roots. 

Treatment.— Removal of the cause. In the ma- 
jority of cases the pulp of the tooth must be re- 
moved. Tincture of iodine to the gums and chloro- 
form or ^oil of cloves to cavities in teeth, might be 
mentioned as temporary measures. 

Describe (a) Sylvesters's method of producing 
respiration ; (b) Laborde's method of producing artifi= 
cial respiration. 

Sylvester's method.— The patient is placed upon 
his back with a folded coat or a pillow beneath the 
interscapular region, the throat is cleared of mucus, 
the tongue held well forward, and all constricting 
clothing removed from throat and abdomen. The 
operator kneels or stands behind the patient. The 
forearms are grasped near the fully flexed elbows and 
the lower portion of the thorax is compressed for a 
few seconds by forcing the patient's elbows against 
the thoracic wall. The arms are then moved out- 
wards and upwards until the hands cross over the 
head. This secures elevation of the costal walls and 
simulates inspiration. The arms are kept in this 
position for a few seconds and then brought down- 
ward to the first position, pressure being made upon 
the costal walls with the elbows of the patient. This 
simulates expiration. These movements are to be 
repeated from twelve to fifteen times a minute. 

Laborde's method. — After clearing the throat of 
mucus, rythmic traction is made upon the tongue. 



ORAL SURGERY. i 47 

Describe the effect of arsenic upon the pulp of a 



tooth. 



The pulp becomes devitalized and there is an 
absence of the previously existing sensibility, as 
may be demonstrated by the use of any exploring in- 
strument. 

State the pathologic changes in chronic inflam= 
mation. 

Dilatation of blood vessels, slowing of current, 
exudation of fluid, transmigration of leucocytes and 
multiplication of the pre-existing connective tissue 
cells of the part. The only difference between acute 
and chronic inflammation is one of degree. In chronic 
inflammation the productive changes are much more 
marked than in the exudative or the degenerative 
ones. 

Describe the healing of wounds, irrespective of the 
anatomic structure of the tissue involved. 

The healing of an aseptic wound will be de- 
scribed. There is a certain amount of exudation, re- 
sulting in the formation of fibrin, which temporarily 
binds the lips of the wound together. This network 
of fibrin serves as a framework for the leucocytes and 
multiplied connective tissue cells. The exudate be- 
comes vascularized and is then known as granulation 
tissue. The leucocytes have nothing to do with the 
building up of tissue. They destroy the fibrin net- 
work and then either return to the circulation or are 
fed upon by the connective tissue cells or fibroblasts. 
The fibroblasts soon become spindle-shaped, and their 



14.8 



ORAL SURGERY. 



ends become split up into primitive fibrillae. This con- 
version of the round fibroblasts into the connective tis- 
sue fibre results in the contraction of the cicatrix, 
which binds the lips of the wound tightly together. 



PATHOLOGY AND THERAPEUTICS. 

What changes occur in inflammation ? 

Primarily. — A marked increase in the velocity of 
the blood-current and a dilatation of the vessels (ar- 
teries and capillaries), caused by a stimulation of the 
vaso-dilator, or a paralysis of the vaso-constrictor, 
nerves, followed by a decrease in the velocity of the 
blood and increased pressure with heightened temper- 
ature and redness. Leucocytes collect along the walls 
of the vessels and migrate through them by a process 
called diapedesis. Exudates pour into the intercellular 
spaces and the part becomes swollen, causing pain by 
pressure upon the nerve filaments. If resolution oc- 
curs, the inflammatory effusions will be taken up by 
the lymphatics and the part restored to health. If, on 
the other hand, suppuration occurs, death of the part, 
or necrosis, may follow. 

What is septicemia and what causes it ? 

It is a condition in which septic matter gains ac- 
cess to the circulating fluids of the body, caused by the 
absorption of the toxic poisons produced by bacteria. 

How do you treat putrescent pulps ? 

The contents of the pulp cavity and canals should 
be sterilized with a ten percent, solution of formalin, 
after which the pulp should be removed with steril- 
ized broaches, great care being exercised not to force 
any of the canal contents into the apical space. Canals 



ISO PATHOLOGY AND THERAPEUTICS- 

should then be thoroughly washed with a ten percent, 
solution of sodium dioxide, followed by an application 
of dilute sulphuric acid. Neutralize the acid with a 
bicarbonate of soda solution, dry with absolute alcohol 
and fill canals with antiseptics on cotton, or fill per- 
manently as indicated. 

What symptoms indicate diseases of the dental 
pulp? 

Paroxysms of pain upon application of thermal 
test, pain upon assuming the recumbent position, 
neuralgic pain along the course of the fifth nerve, and 
pain upon percussion. 

Why is a pulp capped ? When ? How ? 

To preserve its vitality. In young patients when 
the pulp has been exposed by accident in excavating. 
Make a concave disc of gold> platinum, tin or copper, 
large enough to completely cover the exposure; fill 
the disc with a paste made from zinc oxide and one 
of the essential oils, place this over the exposure and 
seal over with zinc oxysulphate. Cover the whole 
with a temporary filling. If pulp continues vital and 
normal for three months or six months, it is reason- 
ably safe to insert a permanent filling. 

What do you mean by pyorrhoea alveolaris ? 

It is a disease of the peridental membrane in 
which this organ, together with the alveolar process, 
undergoes necrosis, causing, as a rule, a flow of pus, 
and recession of the gum tissue. 

How do you distinguish erosion of the teeth and 
caries? 



PATHOLOGY AND THERAPEUTICS, 151 

Erosion of the teeth differs fiom caries in so much 
as it is due entirely to the action of an acid from the 
buccal glands upon the tooth structure, and can be 
distinguished from caries by the polished and trans- 
lucent appearance of the underlying dentine. Caries 
presents a softened surface due to decalcification. 

Which tissue of the tooth dies with the pulp, and 
which remains alive ? 

The dentine dies with the pulp, and the cemen- 
tum remains alive. 

How is the destruction of tissue brought about in 
dental caries ? 

It is brought about by the action of lactic acid, 
the product of carbo-hydrate fermentation through 
the agency of bacteria, which dissolves out the inor- 
ganic constituents of the tooth, leaving the organic 
material to be peptonized and dissolved by bacteria. 

What are parasitic bacteria, and how do they 
cause disease ? 

Parasitic bacteria are those forms which subsist 
upon living animal tissue, producing toxic poisons 
known as toxalbumins, which, when absorbed into 
the circulation, cause disease. 

How does mercuric chloride act as an antiseptic ? 

Mercuric chloride acts as an antiseptic by de- 
stroying bacteria The mercury in the compound 
when brought into contact with albuminous sub- 
stances, combines with the albumen, thereby destroy- 
ing its identity, as well as its vitality. 



152 PATHOLOGY AND THERAPEUTICS. 

What are some of the manifestations of patho= 
logical dentition ? 

In deciduous pathological dentition, we may have 
gastro-intestinal disturbances, marked stomatitis and, 
in severe cases, convulsions may occur. In perma- 
nent dentition, some of the pathological conditions 
most frequently met with are impaction or eruption 
in malposition of third molars, impaction of lateral 
incisors, supernumerary teeth, fusion, irregularities 
as to the number of cusps, odontoceles and dentiger- 
ous cysts. 

What are the principles of treatment in dental 
caries ? 

The employment of an alkaline solution to 
neutralize acids present, removal of carious material, 
the destruction of micro-organisms by the use of 
germicides and the hermetical sealing of the cavity 
by means of rilling materials. 

What is the danger of chronic septic pericemen= 
titis, and what is the treatment ? 

The danger is the opening of the pus cavity 
upon the face, or the infiltration of pus into the tis- 
sues surrounding the tooth, causing necrosis of the 
pericemental membrane and loss of tooth. The 
treatment consists of the mechanical removal by 
warm water of pus masses and the antiseptic treat- 
ment of the affected part, after which mild stimula- 
tion should be employed to hasten the formation of 
granulation tissue. 

Name four agents used in acute diseases of the 
pulp and give the physiological action of each. 



PATHOLOGY AND THERAPEUTICS. ijj 

Tr. Aconite administered in one drop doses re- 
duces the force of the circulation and acts as a seda- 
tive to the nervous system. 

Carbolic acid, being antiseptic and sedative in its 
action, may be used in cases of hyperaemia of the 
pulp. A saturated solution of menthol in chloroform, 
if placed in a cavity of a tooth exhibiting symptoms 
of pulpitis (acute), has an anesthetic and antiseptic 
effect. 

A paste of cocaine and glycerine may also be 
used in cases of pulpitis and acts as an analgesic. 

What causes an alveolar abscess ? 

Access of septic matter to the apical space or 
direct bacterial invasion of that area during an attack 
of apical pericementitis. 

What is phagedenic pericementitis ? 

A disease of the pericemental membrane produc- 
ing necrosis of that organ. In this particular condi- 
tion, calcareous deposits may be present and gingi- 
vitis may not be marked. 

How do you diagnose exostosis ? 

Exostosis is accompanied by the presence of 
vaguely reflected pains, it being usually impossible 
to locate the seat of the trouble ; the X-ray, however, 
demonstrates the condition very efficiently. 

What causes induce periodontitis ? 

Traumatism and septic infection. 

What dangers are to be apprehended from abscess 
upon the temporary teeth ? 



154 PATHOLOGY AND THERAPEUTICS. 

Pus gaining access to the follicle of the perma- 
nent successor interfering with its development. 
Non-resorption of the deciduous root causing mal-erup- 
tion of permanent tooth. Possible necessity for pre- 
mature extraction of the temporary tooth, resulting 
in impaction or mal-eruption of permanent tooth. 

What results are likely to follow abrasion of the 
teeth ? 

Heightened sensitivity of the dentine and de- 
posits of secondary dentine in the pulp cavity. 

What causes superinduce the devitalization of 
non=carious teeth ? 

Traumatism, causing severe hyperaemia and 
death of the pulp by strangulation. This includes 
too rapid wedging as well as too rapid movement in 
regulating cases. 

How would you conduct a thermal test to locate 
an inflamed pulp? 

By isolating each tooth with rubber dam and 
projecting against it, alternately, jets of cold and hot 
water, until the offending member has been located 
by an exaggerated response to the test. 

What is necrosis ? Give some causes. 

Necrosis is the death of any tissue en masse 
caused by an interruption in the process of nutrition. 
Causes. — Thrombus in a terminal artery ; or, liga- 
tion of a vessel cutting off the supply of nutrition to 
the part. 

Which of the permanent teeth are most liable to 
to pathological eruption, and why ? Define pathology. 



PATHOLOGY AND THERAPEUTICS. 155 

The upper and lower third molars. The former 
frequently erupt with their occlusal faces directed 
toward the cheek owing to an insufficient space be- 
tween the second molars and the pterygoid processes 
for their accommodation normally within the arch. 
The lower third molars are more frequently retarded 
in their eruption, also due to lack of space. 

Pathology is the study of tissues in an altered 
physiological condition. 

Describe epulis within tooth cavity. Describe fun= 
goid pulp. 

Epulis within a tooth cavity is a pedunculated 
fibrous growth gaining access to the cavity usually 
through an opening at the bifurcation of the roots of 
molar teeth. This opening is caused by caries. The 
condition resembles very closely fungoid pulp, a hy- 
pertrophic condition of the pulp which is fibrous in 
character and highly vascular. 

What is resorption of the roots of deciduous teeth ? 
Is it a physiological or a pathological condition ?. 

Resorption of the deciduous roots is a physiologi- 
cal condition brought about by the action of giant 
multinucleated cells, probably modified leucocytes; 
these dissolve the substance of the roots, which is 
then taken up and carried away by the circulation. 
This condition is stimulated by pressure caused by 
the growth of the permanent successor. 

In what abnormal condition will resorption of the 
temporary teeth cease ? 

In temporary teeth containing putrescent pulps, 



ij6 PATHOLOGY AND THERAPEUTICS. 

or a devitalized pericemental membrane in a sup- 
purating condition, resorption does not occur. 

Describe and give the supposed causes for Hutch= 
in son's teetti. 

Hutchinson's teeth present a notched appear- 
ance upon the cutting edges, the longitudinal axes 
of these edges being shortened. The supposed cause 
is congenital syphilis. 

How is pulp irritation from loss of tooth substance 
distinguished from sensitive dentine ? 

If exaggerated pain is experienced from contact 
with instruments upon the abraded surface, the 
condition is that of sensitive dentine. If this contact 
causes but a mild response and the thermal test pro- 
duces marked paroxysms of pain, the condition may 
be diagnosed as irritation of the pulp. 

What results may follow the premature extraction 
of the temporary molars ? 

The first permanent molar may tip forward and 
occupy the space which the second bicuspid should 
take upon eruption, thereby causing either mal-erup- 
tion or impaction of the bicuspid tooth. 

How would you differentiate between pericementitis 
and alveolar abscess ? 

In pericementitis, the pericemental membrane 
becomes thickened, the tooth elongated and extremely 
sensitive to percussion. A reddening of the gum 
tissue is noted over the affected tooth. In alveolar 
abscess we have an exaggerated likeness to these 



PA THOL OGY AND THERA PE UTICS. 157 

symptoms together with swelling over the affected 
tooth, intense pain with a subsequent discharge of 
pus. 

Name some of the pathological conditions of the 
dental pulp. 

Passive and active hyperaemia, pulpitis, pulp 
nodules, dry and moist gangrene and pulp hyper- 
trophy. 

Give the cause of dental exostosis and describe 
the symptoms. 

The cause of dental exostosis may be extraction of 
the occluding tooth, the pericementum not being met 
by the accustomed resistance, proliferates cementum 
upon the apex of the root. Or, traumatic injury, caus- 
ing continued mild irritation of the pericementum, 
may give rise to a like condition. The symptoms are 
gnawing pains in the affected tooth, sometimes assum- 
ing a reflected neuralgic type. 

Mow would you diagnose and locate an inflamed 
pulp where no cavity exists ? 

By the thermal test. 

What is meant by the pathology and morbid 
anatomy of a disease ? 

By the pathology of a disease is meant the study 
of the alterations in physiology which lead up to it, 
i. e., its pathogenesis. By morbid anatomy of a 
disease is meant a consideration of the altered ana- 
tomical conditions. 

What are bacteria ? Distinguish between sapro- 
phytic and parasitic. 



i £8 PATHOLOGY AND THERAPEUTICS. 

Bacteria are minute organisms representing the 
lowest order of plant life. Saprophytic bacteria sub- 
sist upon dead organic matter, while the parasitic 
variety derive their nourishment from living organ- 
isms. , - 

Give the symptoms of septicaemia. 

The general symptoms of septicaemia are fever 
and chills, diarrhoea, rapid and weak pulse and 
clammy condition of the skin. If the infection has 
been from a wound, the discharge coming from it 
will be putrid. 

What conditions are necessary for the growth and 
development of bacteria ? 

Proper food supply, removal of waste products, 
moisture, sufficient temperature and the presence of 
free oxygen. This last named condition, however, is 
not necessary for the existence of the anaerobic 
bacteria. 

How do bacteria multiply ? 

Bacteria reproduce through the medium of spores, 
and by fission. 

Give Miller's theory of dental caries. 

The presence of sugar in the mouth causes fer- 
mentation and the production of acids which dissolve 
out the lime constituents of the teeth. Micro-organ- 
isms gain access to the dentinal tubuli and prolifer- 
ate; they follow in the wake of the decalcifying pro- 
cess and subsist upon the organic tooth substance, 
producing acids. 



PATHOLOGY AND THERAPEUTICS. 159 

By what and under what conditions is pus pro= 
duced ? 

Pus is produced by the invasion of the staphylo- 
coccus pyogenes aureus, citreus or albus, or by strepto- 
coccus pyogenes, the gonococcus, the bacillus pneu- 
monae or other pyogenic organisms into an area sus- 
ceptible to inflammatory changes, or already inflamed. 
The white blood corpuscles together with other wan- 
dering cells of the body, are devitalized by the bac- 
teria and become pus corpuscles. 

What are leucocytes and what are their functions ? 

Leucocytes are the white blood corpuscles. They 
exercise phagocytic activity, devouring and carrying 
away invading bacteria and other irritating organic 
substances which gain access to the tissues. 
How is fermentation produced ? 

Fermentation is produced by the action of micro- 
organisms upon solutions of organic substances ex- 
posed to the air. 

Name some of the pathogenic fungi found in the 
mouth. 

Micrococcus of sputum septicaemia. 
Bacillus salivarius septicus. 
Micrococcus gingivae pyogenes. 
Saccharomyces albicans. 
Pneumo-bacilliis. 

What is meant by lactic fermentation and why is 
it of extreme interest to dentists? 

Lactic fermentation is that process or change 
which occurs in solutions of the fermentable carbohy- 



160 PATHOLOGY AND THERAPEUTICS. 

drates, producing lactic acid. This product is of in- 
terest to dentists, as it is the prime factor in the pro- 
duction of dental caries. 

How are cultures of bacteria made ? 

Cultures of bacteria are made by first arranging 
a suitable medium, or field for the growth of the or- 
ganisms. Bouillons, gelatinous fluids, gelose, po- 
tato, serum, etc., are used for this purpose. The me- 
dia are usually sterilized by heat. The infected mat- 
ter is placed upon the medium and subjected, as a rule, 
to a proper temperature in an incubator. 

Name three recognized classes of bacteria. 

Bacteria are classed according to their form as 
micrococci (spherical), bacilli (rod- like) and spirillae 
(curved). 

Through what channels do bacteria gain access to 
the system? 

They gain access through open wounds or breaks 
in the skin, or mucous membrane, and by the mouth or 
nose into the gastro-intestinal tract, and lungs, where 
they enter through the mucous membrane. 

What is meant by regeneration of tissue and how 
is it brought about ? 

By regeneration is meant the return of a tissue 
to a state of normality after its having been the seat 
of inflammatory processes. This is brought about 
by the removal of the inflammatory effusions by the 
phagocytic action of leucocytes and absorption by 
the lymphatics. Bmbryonic connective tissue now 



PATHOLOGY AND THERAPEUTICS. 161 

appears and a network of newly formed blood vessels 
is constructed in it by a process of budding. This 
mass is known as granulation-tissue. Most of the 
newly formed vessels undergo atrophy after perfect 
regeneration has occurred, leaving a pale area or 
cicatrix. 

What effects may be produced in the mouth from 
the administration of large doses of calomel? Describe 
the condition. 

Large doses of calomel produce a condition 
known as mercurial stomatitis. The gums around 
the necks of the teeth become inflamed and swollen, 
ulceration of the mucous membrane occurs, the teeth 
become loosened, and there is a marked increase in 
the flow of saliva. The breath is fetid, and there is 
an unpleasant metallic taste in the mouth. The 
severity of these symptoms depends upon the suscep- 
tibility of the patient, as, in some cases, loss of the 
teeth occurs, and even necrosis of the maxillary 
bones. 

Give the differential diagnosis between an abscess 
and a cyst. 

The development of an abscess is accompanied 
by the most extreme pain and does not show exter- 
nally any alteration in the anatomy of the part, until 
the late stage. . A cyst is seen to enlarge, expanding 
the bone tissue which envelops it, its development 
being accompanied by a little or no pain. In the 
dentigerous cyst, pressure upon the walls produces 
crepitation or crackling. 



162 PATHOLOGY AND THERAPEUTICS. 

Differentiate between hyperaemia, inflammation 
and suppuration. 

Hyperaemia is an excess of blood in a part. In- 
flammation is the succession of changes (hyperaemia 
being one of these changes) which occnr in a tissue 
during its effort to rid itself of an irritant, provided 
the irritant is not of sufficient strength to cause im- 
mediate death of the part. If, in the last stages of 
inflammation, resolution does not occur, and pyogenic 
organisms invade the inflamed area, suppuration, or 
the formation of pus, will occur. 

Describe the process of a formation of an apical 
alveolar abscess. 

Septic matter, having gained access to the apical 
space, irritates the part producing hyperaemia, which 
later assumes the type of apical pericementitis. Dia- 
pedesis occurs, the white blood corpuscles attacking 
the micro-organisms, exudates are poured out from 
the vessels, and the pericementum may be stripped 
from the root, forming a sac in which the dead leuco- 
cytes and exudates (pus) accumulate. The abscess 
will vent itself and discharge either through the pulp 
canal, at the neck of the tooth, or will burrow through 
the alveolus and gum tissue at a point in the direc- 
tion of least resistance. Its entrance to the process 
is marked by a deep redness of the gum over the 
apex. Its entrance to the gum tissue produces a lessen- 
ing of painful tension and causes a tumefaction of 
the gum and sympathetic swelling of associate parts. 

What is the source of nourishment of bacteria ? 
How do they obtain oxygen ? 



PATHOLOGY AND THERAPEUTICS 163 

Bacteria contain no chlorophyl, and, therefore, 
have not the power to decompose water and carbon 
dioxide nor to effect the synthesis of starch. Hence, 
they are compelled to derive their nourishment from 
existing organic compounds. According to their 
method of obtaining oxygen, bacteria are divided into 
three classes : anaerobic, those depending upon the 
presence of free oxygen ; aerobic, those not requiring 
free oxygen, as they possess the power to appropriate 
the oxygen from unstable organic combinations ; and 
facultative or those which flourish in either condi- 
tion. 

What is salivary calculus, where is it found, and 
what effect has it ? 

Salivary calculus is a deposition of the salts of 
lime (carbonate and phosphate), held in solution in 
the saliva, upon the surfaces of the teeth, usually 
near the gum margin, in proximal spaces and deep 
sulci. Carbon dioxide plays an active part in the 
precipitation of the calculus. Large deposits are fre- 
quently found near Steno's duct, the opening of the 
parotid gland, and on the lingual and labial surfaces 
of the lower anterior teeth. Deposits of tartar have 
the effect of producing recession of the gum, causing 
sufficient irritation at times to produce inflammation 
and even suppuration. If allowed to continue, the 
deposits may be responsible for affections of the peri- 
cemental membrane and alveolar process, and also 

tooth loss. 

What is the difference between an antiseptic and 
a germicide, and give examples ? 

' Antiseptics prevent the action of pathogenic or- 



1 6 £ 



PA THOL OGY A ND THERA PE UTICS. 



ganisms and their products on the living body, but 
do not necessarily kill the micro-organisms. Germi- 
cides destroy the vitality of the germs of disease. 
They are antiseptics, though antiseptics are not neces- 
sarily germicides. Iodoform is an antiseptic; mer- 
curic chloride is a germicide. 

What is pyrozone ? How does it act, and for what 
is it used ? 

Pyrozone is a solution of hydrogen dioxide in 
water or ether. A 3% aqueous solution acts as an 
antiseptic and disinfectant; these properties are due 
to the setting free of oxygen when the solution is 
brought in contact with organic matter. In this 
strength, it is valuable in cases of ulcerative stoma- 
titis, and also in softening deposits of calculus. For 
cleansing pus pockets, it is an effective agent. A 25% 
ethereal solution is used as a bleaching agent, caustic 
and styptic. 

How are the diseases of the pericementum diag= 
nosed from those of the pulp ? 

Diseases of the pericementum respond freely in 
paroxysms of pain to any pressure brought to bear 
upon the tooth, while pulp disorders are demonstrated 
by the thermal test. Pericemental disorders can al- 
ways be located by the patient. Pains from pulp 
affections are more often reflected. When one is com- 
plicated by the other both symptoms may be in evi- 
dence. 

At what age is the first permanent tooth erupted, 
and which tooth is it ? 

The first permanent tooth is erupted at about 



PATHOLOGY AND THERAPEUTICS. i6 5 

the sixth year; it is called the first molar, or sixth 
year molar. 

How do you treat hypersensitive dentine ? 

In the treatment of hypersensitive dentine the 
rnbber dam should be applied if possible and abso- 
lute dryness secured. This, in itself, ofttimes produces 
sufficient anaesthesia to permit instrumentation. In 
obstinate cases, however, it may be necessary to em- 
ploy other therapeutic measures. If the cavity be not 
deep, a solution of caustic soda (ten grains to the 
ounce of water) is sometimes effective. A paste of 
cocaine muriate and glycerine, sealed in the cavity 
for 24 hours, may be used with good results. Cocaine 
may also be employed by cataphoresis. Carbolic 
acid, chloroform, ethyl or methyl chloride (in spray) 
are also indicated. In cases of hypersensitivity of 
abraded teeth (where no cavity exists), the tooth or 
teeth should be isolated by the rubber dam and 
strong mineral acids, such as nitric, sulphuric and hy- 
drochloric should be applied. These agents coagu- 
late the contents of the tubules. The surfaces, treated 
in this manner, should always be excavated and 
filled. 

What dangers must be guarded against in the 
use of arsenic for devitalizing the pulp of a tooth ? 

Arsenic, for the purpose of devitalizing the pulp, 
should be employed with great care. If carelessly 
applied, a minute portion may come in contact with 
the gum tissue or be insinuated in the gingival space, 
producing sloughing of the peridental membrane and 



1 66 PATHOLOGY AND THERAPEUTICS. 

gum tissue, or necrosis of the process, or both. 
Great care should be exercised in sealing arsenic in a 
cavity to prepare the margins of the cavity in such a 
way as to permit hermetical sealing. Pastes of arsenic 
should be applied without an excess of fluid, as 
there is danger of oozing about the margins during 
the process of sealing. This drug should never be 
used for the devitalization of pulps in deciduous teeth. 

Give the differential diagnosis between hype= 
raemia, inflammation and suppuration of the pulp. 

In hyperaemia the pulp responds to the applica- 
tion of heat or cold in a somewhat exaggerated 
degree, owing to the dilatation of the vessels. Cases 
of hyperaemia usually give a history of mild attacks 
of odontalgia, transient in character. In inflamma- 
tion of the pulp the response to cold is somewhat 
diminished ; the application of heat produces pain of 
a severe type. Odontalgia becomes constant, throb- 
bing in character, increasing when the patient resumes 
a recumbent position. Neuralgic pains ma}^ be felt 
along the course of the fifth nerve. Suppuration 
begins in the late stage of inflammation, and is indi- 
cated by a cessation of response to cold applications. 
Heat produces agonizing paroxysms of pain only 
alleviated by the immediate application of cold. The 
pain now assumes a gnawing character, persistently 
increasing, while throbbing ceases. 

What are the principles of treatment in pyor= 
rhoea alveolaris ? 

The removal of all existing calcareous deposits ; 
the washing out of the gingival spaces with warm 



PATHOLOGY AMD THERAPEUTICS. i6y 

antiseptic alkaline solutions ; the polishing of all sur- 
faces of the teeth ; and the employment of stimulat- 
ing antiseptic germicidal mouth washes. The em- 
ployment of constitutional tonics is also indicated. 

What are saprophytic bacteria, and how do they 
cause disease ? 

Saprophytic bacteria are those forms which flourish 
upon dead organic substances, effecting their decom- 
position, producing toxic poison, through the agency 
of which they become causes of disease. 

What objections are there to the premature ex- 
traction of the temporary teeth ? 

Premature extraction of the temporary teeth is 
followed by insufficient space for the normal eruption 
of their permanent successors, resulting in malposed 
permanent teeth, and, not infrequently, their im- 
paction. 



PATHOLOGY. 

What are spores ? How may nutrient media be 
freed from spores at a temperature below ioo degrees C. ? 

Spores are reproductive bodies of lower vegeta- 
ble organisms (of bacteria, for example). 

Nutrient media may be freed from spores at a 
temperature below ioo° C. by the process of frac- 
tional sterilization. The nutrient media are exposed 
to a temperature of 8o° C. for 15 minutes. This 
destroys the bacteria and the media are then kept at 
the room temperature for 24 hours so that the spores 
may develop into bacteria. These bacteria are de- 
stroyed by an exposure to 8o° C. for 15 minutes 
upon the second day. This process is repeated the 
third and sometimes the fourth day, at which time 
the media will be free from spores. 

Define Pathology. 

Pathology is that branch of medical science 
which treats of modifications of function and changes 
in structure caused by disease. 

Define leukomains. State where they are found. 

By leukomains are meant any of the nitrogenous 
bases or alkaloids normally developed by the metabolic 
activity of living organisms, as distinguished from 
the alkaloidal substances developed in dead bodies 
and called ptomains. 

They have been found in almost all of the 
tissues of the body. 



PATHOLOGY. i6 9 

ilention the different kinds of tumors of the 
gums ? 

Simple epulis (fibroma), malignant epulis (mye- 
loid sarcoma), round-celled sarcoma, spindle-celled 
sarcoma, and epithelioma. 

State the difference between parasites and sapro= 
phytes. 

A parasite is an animal or vegetable organism 
living upon or within another living organism. 

A saprophyte is a vegetable organism living 
upon dead organic matter. 

How may inflammation terminate ? 

Inflammation may terminate by resolution, re- 
trogression (the formation of cicatricial tissue), sup- 
puration, ulceration, or gangrene. 

Name the various tumors of the tongue. 

Papilloma, fibroma, lipoma, myxoma, angioma, 
lymphangioma, and epithelioma. Lymphadenoma 
and lymphosarcoma may occur at the root of the 
tongue. Chondroma has also been found in the sub- 
mucous tissue of the tongue. 

What is the most common syphilitic lesion upon 
the tongue ? 

Mucous patches. 

What is inflammation ? 

Inflammation is the succession of changes which 
occur in a living tissue when it is injured, providing 
the injury is not of such a degree as to at once de- 
stroy its structure and vitality (Burdon Sanderson). 



jyo PATHOLOGY. 

It is " the response of living tissue to injury." 
Define sepsis, asepsis. 

Sepsis is a condition of poisoning produced by 
the absorption of putrefactive substances. 

Asepsis is the absence of pathogenic micro- 
organisms. 

Give the differential diagnosis between sarcoma 
and carcinoma. 

A sarcoma arises from connective tissue, may 
occur at any age, may be encapsulated, gives metas- 
tasis through the blood vessels, and the overlying in- 
tegument frequently contains dilated veins. 

A carcinoma arises from epithelial tissue, usually 
occurs after middle life, is never encapsulated, and 
gives metastasis through the lymphatic vessels. 

What is the difference between a ptomain and a 
toxin ? 

A ptomain is a basic compound resembling the 
alkaloids, formed during the decomposition of animal 
or vegetable tissues. 

A toxin is an} 7 poisonous substance, either albu- 
minous or basic, produced by the action of bacteria 
upon organic matter. 

A toxin is a poisonous ptomain. 

Name three tumors of the superior maxilla and 
give the pathology of one. 

Osteoma, carcinoma, and sarcoma. 

Sarcoma originates from the anterior wall or 
from the cavity of the antrum or from the spheno- 



PATHOLOGY. i 7 i 

maxillary fossa behind the bone. The maxilla may 
be secondarily involved by sarcomatous nasopharyn- 
geal polypi which extend from the nose. These 
growths frequently contain considerable ossific de- 
posits and this is occasionally so extensive that the 
antral cavity is obliterated and the bone converted in- 
to a solid mass. 

Name tumors of the buccal parietes. 

Papilloma, naevus, cavernous angioma, and epi- 
thelioma. 

Mention four forms of abscesses. 

Acute or hot, chronic or cold, residual, and me- 
tastatic. 

What is an embolus? 

An embolus is a particle of fibrin or other ma- 
terial which is swept into the blood current and which 
is capable of forming an obstruction at its place of 
lodgment. 

What is an aneurism ? Mention three varieties. 

An aneurism may be defined as a sac containing 
blood and communicating with the interior of an ar- 
tery. 

Fusiform, saccular and dissecting. 

Mention five forms of inflammation. State how 
inflammation may terminate. 

Fibrinous, diphtheritic, suppurative, hemorr- 
hagic and' gangrenous. 

Inflammation may terminate in resolution, re- 
trogression, suppuration, ulceration, or gangrene. 



172 PATHOLOGY. 

What are the active agents in decomposition ? 

The active agents in decomposition are the sapro- 
phytic bacteria. 

Define pasteurization. How does pasteurization 
differ from disinfection and sterilization ? 

Pasteurization is a process of checking fermen- 
tation in organic fluids by heating them to 60 ° or 
7o°C. 

It differs from disinfection since, in disinfection , 
the bacteria are destroyed by the use of chemical 
agents. 

It differs from sterilization, since in sterilization, 
the temperature is carried higher and the bacteria are 
destroyed, whereas in pasteurization the temperature 
is simply raised to a point where few fungi can 
flourish. 

Give the lesions in syphilitic affections of the buc- 
cal mucous membrane. 

The initial lesion (chancre) may rarely occur in 
this situation. In secondary syphilis there is often 
a chronic inflammation of the buccal mucous mem- 
brane and mucous patches (mucous tubercles, con- 
dylomata) are not infrequently present. 

State what micro=organisrns produce pus. 

Staphylococcus pyogenes aureus, staphylococcus 
pyogenes albus (staphylococcus epidermidis albtis), 
staphylococcus pyogenes citreus, streptococcus, bacil- 
lus coli communis, bacillus typhosus, pneumococcus 
and gonococcus. 

Describe the structure of a bacterial cell. 



PATHOLOGY. i 73 

The cell is principally composed of an albumin- 
ous substance known as mycoprotein. There is a 
large nucleus situated in the centre of the cell consti- 
tuting its great bulk. This is surrounded by a very 
delicate cell-wall. In some bacteria, cilia or flagella 
may be observed extending away from the cell-wall. 
In other bacteria, the cell-wall seems to undergo a 
gelatinous transformation so that the bacteria seem to 
be surrounded by a halo or capsule (pneumococcus). 

State the difference between benign and malig- 
nant tumors, 

Benign tumors are usually encapsulated, do not 
give metastasis, do not recur upon removal, produce 
no cachexia, grow slowly, do not infiltrate, are not pain- 
ful (except by pressure), and do not cause death (ex- 
cept by location). 

Malignant tumors are never effectively encapsu- 
lated, give metastasis, recur upon removal, produce 
cachexia, usually grow rapidly, infiltrate, are pain- 
ful, and cause death. 

What is the usual source from which pathogenic 
bacteria are derived ? State the conditions under which 
m,cro=organisms get into the air. 

Pathogenic bacteria are practically always derived 
indirectly from the bodies of diseased human beings 
or lower animals. They may be inhaled with the 
air (tuberculosis), ingested with the liquids or food 
(cholera and typhoid), or gain access through wounds. 

The micro-organisms get into the air from the 
soil. The excreta of diseased individuals becomes 



114 PATHOLOGY. 

dried, ground up into dust, and these dust particles 
loaded with, bacteria are disseminated by the winds. 
Micro-organisms rarely pass from fluids into the air. 
Describe a method of making gelatine plates. 

Three tubes of sterile gelatine are to be liquefied 
by heat. Tube No. i is inoculated with the 
infectious material by means of a platinum wire. 
Tube No. 2 is now inoculated from tube No. i, 
and tube No. 3 is inoculated from tube No. 2. The 
contents of these tubes are now poured into three 
previously sterilized Petri dishes. In all of these 
manipulations, precautions must be taken to avoid 
accidental contamination of the culture medium. 
Differentiate thrombosis and embolism. 

By thrombosis is meant a clotting of the blood 
within the heart or blood-vessels. It is due to a 
slowing of the current, or to an altered condition of 
the blood or blood-vessel walls. 

By embolism is meant the obstruction of a blood- 
vessel (particulary an artery) by a fragment of mat- 
ter brought from another point. This fragment of 
matter or embolus may be a detached piece of a throm- 
bus. 

How does suppuration spread ? 

Suppuration spreads by the peptonization of the 
inflammatory exudate by the pyogenic cocci. It 
spreads in the direction of least resistance. 
Describe Miller's theory of dental caries. 

The lactic acid, generated from starchy foods by 
the organisms of lactic acid fermentation, dissolves 
the calcium salts from the teeth, leaving the organic 



PATHOLOGY. i 75 

constituents which are then destroyed by the organ- 
isms always present in the mouth. These organisms 
are able to carry on their work indefinitely, since the 
lactic acid is quickly neutralized in the process of 
tooth solution and the germs do not die of poisoning 
by their excreta. 

State the usual method of cultivating bacteria. 

The usual method of cultivating bacteria is to in- 
oculate any of the ordinary culture media with the 
bacteria in question, and then to keep the media under 
conditions favorable for the growth of the micro-or- 
ganisms. Bouillon, agar agar, potato, etc. may be 
kept in the brood-oven; gelatine is kept at room- 
temperature. 

Define oral pathology. 

Oral pathology is the study of the modifications 
of function and changes in structure as they occur in 
the mouth and adjacent parts. 

Hention the principal diseases of the maxillary 
bones. 

Osteo-myelitis and its sequelae, alveolar ab- 
scesses, periostitis, tuberculosis, syphilis (gummata), 
osteoma, chondroma, fibroma, myxoma, carcinoma, 
sarcoma, and empyema (upper jaw). 

Describe the histologic structure of carcinoma. 

The structure will vary according to the region 
involved. The tumor is made up of epithelial cells 
and a stroma of connective tissue. In epithelioma of the 
skin, the cells are of a squamous type; in carcinoma of 



iy6 PATHOLOGY. 

mucous membranes, they are cylindrical and there 
is a tendency to the formation of cuboidal epithelium. 
The cells show secondary changes (dropsical infiltra- 
tion, mucoid degeneration, fatty degeneration, etc .). 
Karyokinetic figures may be abundant and are fre- 
quently atypical. 

The epithelial cells are usually grouped into 
acini or into alveoli containing several layers of epi- 
thelial cells. At the periphe^ of the acini, the cells 
may break through the basement membrane. 

The connective tissue stroma is of varying den- 
sity, but is always of a fibrous character. It is arranged 
so as to form hollow spaces which contain the epithe- 
lial cells. 

What are the active causes of carcinoma of the 
buccal cavity ? 

Any irritation such as smoking, a sharp tooth, 
the stem of a pipe, or a badly fitting plate. Leuko- 
plakia, chronic glossitis, and probably caustics. 
What is the cause of pain in inflammation ? 

The pain in inflammation is caused by the exu- 
date stretching and pressing upon the filaments of 
the sensory nerves. Another factor in the production 
of inflammatory pain is the chemical irritation of the 
sensory filaments by the toxins produced by the bac- 
teria. 

What is the difference between catarrhal and sup= 
purative inflammation ? 

In catarrhal inflammation there is usually con- 
siderable liquid exudation, retension cysts may 



PATHOLOGY. i 77 

form in the mucous glands, and even localized ero- 
sions may appear. There is a hypersecretion of mu- 
cus and a desquamation of epithelium. 

In suppurative inflammation, the exudate con- 
tains a large amount of leukocytes which are killed 
and transformed into pus cells. 

What is periostitis ? 

Periostitis is an inflammation of the periosteum. 
What is provisional callus, and where is it found ? 

Provisional callus is the temporary splinting ma- 
terial which nature throws out about the ends of 
fractured bones. 

It is found outside of the ends of the fragments 
(ring callus) and within the medullary cavities of the 
fragments (pin callus). 

Give some of the pathologic and anatomic charac- 
teristics of a benign tumor. 

Benign tumors usually resemble the tissue from 
which they grow, tend to unlimited growth, are en- 
capsulated, do not adhere to surrounding structures, 
do not infiltrate, do not give rise to metastasis, do not 
recur when thoroughly removed, have a nutrition 
which is independent of the general nutrition of the 
body, and do not cause death (except mechanically). 

What is meant by intermediate or definitive cal- 
lus ? Where is it found ? 

Definitive callus is the callus which ultimately 
unites the fragments of fractured bone. It is the 
metamorphosis of this tissue that results in bony 
union. 



178 PATHOLOGY. 

It is found between the ends of fractured bones. 

What effect has increased nutrition on tissues ? 

It may result in fatty infiltration, in more rapid 
growth, or in hypertrophy. 

What effect has imperfect nutrition on tissues? 

It causes them to degenerate and atrophy. 

Differentiate between syphilitic and congenital 
cleft palate. 

Syphilitic perforation is practically always due 
to a broken down gumma. There will be a history of 
preceding syphilis and concomitant lesions in some 
portion of the body. The perforation will have 
been accompanied by marked inflammatory symptoms, 
well remembered by the individual. 

Congenital cleft palate is present at birth and is 
due to a failure of union of the two palatal processes. 
Differentiate fibrous from sarcomatous epulis. 

Fibrous epulis grows slowly, is hard, painless » 
pale-red, and rarely attains a larger size than that, 
of a walnut. 

Sarcomatous epulis grows rapidly, is softer, pain- 
ful, livid in color, ulcerates sooner, and may attain 
the size of an apple . 

riention the tumors of the buccal cavity. 

Fibroma, lipoma, myxoma, chondroma, osteoma, 
lymphadenoma, lymphosarcoma, spindle-celled sar- 
coma, myeloid sarcoma, papilloma and carcinoma. 

Define abscess. State of what the walls of an 
abscess consist and describe its growth. 



PATHOLOGY. i 79 

An abscess is a circumscribed collection of pus 
in a cavity of abnormal formation. 

The walls consist of granulation tissue. 

The vessels of the affected area become dilated 
and the various elements of the blood pass through 
the walls. As the pyogenic organisms develop, re- 
tardation and stasis followed by thrombosis occur 
successively, whilst the exudation of cells becomes 
so great that the original tissue of the part disap- 
pears, after passing through a stage of coagulation 
necrosis. This removal of the infiltrated tissues is 
largely caused by their liquefaction, owing to the 
peptonizing power of the bacteria. 

State how a dead pulp may cause empyema of the 
maxillary sinus. 

The dead pulp may become infected and give 
rise to an alveolo-dental abscess, which ruptures into 
the maxillary sinus or causes a purulent inflamma- 
tion of its lining by contiguity of structure. 

Define atrophy. Give the etiology and pathologic 
anatomy of atrophy. 

Atrophy is a reduction in bulk of one or more 
of the component parts of an organ, and the func- 
tional activity is reduced. 

The organ is reduced in size ; its consistency 
may be increased ; the outline of the organ may be- 
come irregular and there is an increase of pigment. 
The microscope shows a reduction in the size of the 
individual cells. 

Give an effective method of sterilizing hypoder= 
mic syringes. 



180 PATHOLOGY. 

The modern hypodermic syringe consists en- 
tirely of metal and can be effectively sterilized by 
boiling it for five minutes in a \% solution of sodium 
carbonate. 

If boiling water is drawn up into the old glass 
and metal syringe and then ejected, and this is re- 
peated six or eight times, the syringe will be practi- 
cally sterile. This method is more reliable than 
solutions of carbolic acid or bichloride (Eiselsberg). 

State in what manner micro=organisms enter the 
body. 

Through the respiratory tract, through the gas- 
tro-intestinal tract, through solutions of continuity of 
the skin and mucous membranes, and through the 
placenta. 

State the difference between asepsis and anti- 
sepsis. 

In asepsis, an effort is made to prevent the en- 
trance of germs into a wound. The greatest reliance 
is placed upon mechanical purification and upon 
sterilization by heat. 

In antisepsis, an effort is made to destroy the 
germs in a wound as well as to prevent the entrance 
of more bacteria. The greatest reliance is placed 
upon chemical agents. 

How and under what conditions do bacteria mul= 
tiply ? 

Bacteria multiply by fission (direct division), and 
by sporulation (development of spores). 

The following conditions are requisite for the 
multiplication of bacteria : 



PATHOLOGY. 181 

i. Presence of oxygen (aerobic bacteria). Ab- 
sence of oxygen (anaerobic). 

2. A certain amount of organic matter. 

3. A certain amount of moisture. 

4. A neutral or feebly alkaline reaction, for the 
majority of bacteria. 

5. A temperature above 16 ° C and below 
40 C. 

6. The majority of bacteria multiply most 
rapidly when the medium in which they grow is at 
rest. 

Define toxin, antitoxin, ptornain, virulent germ, 
non=virulent germ. 

A toxin is any poisonous substance, either albu- 
minous or basic, produced by the action of bacteria 
upon organic matter. 

An antitoxin is a counter poison elaborated by 
the body to counteract the toxins of bacteria. 

A ptornain is a putrefactive alkaloid formed dur- 
ing the decomposition of animal or vegetable tissues. 

A virulent germ is one having marked patho- 
genetic properties. 

A non-virulent germ is one, the pathogenetic 
properties of which are not marked. 

Differentiate hypertrophy and tumor. 

An hypertrophy is an increase in bulk of a tissue 
or organ occurring independently of the general 
growth of the body. In a true hypertrophy the func- 
tion is increased. 



182 PATHOLOGY. 

A tumor is an atypical new formation tending to 
unlimited growth, having no function, differing from 
the tissue in which it is found in gross and minute 
structure, the nutrition of which is independent of 
the nutrition of the body in general, and which is 
not dependent upon or coincident with inflammation. 

What are pathogenic bacteria ? State how patho= 
genie bacteria incite disease processes. 

Pathogenic bacteria are those which produce 
disease. 

After gaining entrance to the tissues they may 
incite disease processes in one of the following ways: 

They may grow so rapidly that they completely 
block up the blood and lymphatic channels. 

They may cause a local inflammation due partly 
to the presence of the foreign organisms and partly to 
their toxic metabolic products. 

More often, however, they produce powerful me- 
tabolic poisons which destroy the tissues immedia- 
tely acted upon, or circulate through the organisms 
and overthrow the normal physiologic equilibrium. 

Define carcinoma. Give with reference to carci= 
noma ^a) congenital theory, \h\ traumatic theory, (c) 
clinical appearance. 

A carcinoma is a malignant epithelial tumor, 
composed of a connective tissue stroma, surrounding 
groups or nests of epithelial cells. 

(a) Congenital theory. — The carcinoma is sup- 
posed to grow from embryonal rests or "resting 
spores." 



PATHOLOGY. i8j 

(b) Traumatic theory.^-The carcinoma devel- 
ops as the result of a single traumatism or of re- 
peated irritations. 

(c) Clinical appearance. — The tumor occurs in 
an individual past middle life, is fixed to the surround- 
ing tissues and may be ulcerated. The neighboring 
lymphatic glands are enlarged, the tumor is the seat 
of lancinating pain, and cachexia is present. 

Distinguish between pathologic regeneration and 
physiologic regeneration. 

Physiologic regeneration is that which occurs in 
the normal life of the organism, and by which the 
cellular wear and tear is counterbalanced. The tissue 
destroyed is replaced by similar tissues. 

Pathologic regeneration is the more massive and 
open atypical reconstruction that follows disease or 
injuries. The tissue destroyed is almost always re- 
placed by connective tissue. 

What is disinfection ? How may the strength of a 
disinfectant be determined ? 

Disinfection is the destruction of micro-organ- 
isms, particularly by the action of chemicals. 

The strength of a disinfectant may be deter- 
mined by bringing definite quantities of the infected 
material in contact with definite quantities of a 
series of solutions of graded strengths, and subse- 
quently making cultures from the infected material, 
w T hich has been thus exposed, to determine whether 
the organisms have been completely destroyed. 



184 PATHOLOGY* 

How do wounds heal ? 

Wounds heal: 

i. By immediate union. 

2. By first intention. 

3. By organization of a blood clot. 

4. Under a scab. 

5. By second intention (granulation). 

6. By third intention (adhesion of granulating 
surfaces) . 

By the first four methods the wound heals with- 
out the formation of pus; in the last two methods 
suppuration is present. 

riention the different varieties of tumors of the 
superior maxilla. 

Myxoma, fibroma, chondroma, osteoma, odon- 
toma, sarcoma, and carcinoma. 

Define pus. Give the specific gravity and varie- 
ties of pus. 

Pus is a thick, opaque, creamy fluid; it is smooth 
and slightly glutinous to the touch, has a faint odor 
and a slightly sweetish taste. It is neutral or feebly 
alkaline in reaction. 

The specific gravity of pus varies between 102 1 
and 1042. 

The varities of pus are: Healthy pus, ichorous 
pus, sanious pus, fetid pus, curdy pus, muco-pus, 
and sero-pus. 

Define suppuration. 

By suppuration is meant the formation of pus. 
Define diathesis. 



PATHOLOGY. 185 

A state or condition of the body whereby it is 
especially liable to certain diseases. It may be ac- 
quired or hereditary. 

Define cachexia. 

A depraved condition of general nutrition due to 
some serious disease, such as syphilis, tuberculosis, 
carcinoma. 

Into what classes are bacteria divided ? 

According to their morphology, bacteria are di- 
vided into: (1), Cocci, (2), Bacilli; (3), Spirilla. These 
are relatively monomorphous. Three other varieties 
might be mentioned, (4), Spirulina; (5), Lepto- 
thrix; (6), Cladothrix. These are relatively pleomor- 
phous. 

Define plethora, anemia, hyperemia. 

By plethora is meant an increase of the total 
amount of the blood in the body. 

By anemia is meant a deficiency of the 
blood as a whole, a deficiency of the red blood, or of 
the hemoglobin. 

By hyperemia is meant an increased amount of 
blood in the more or less dilated vessels of a part. 



THERAPEUTICS 
AND MATERIA MEDICA. 

What is meant by idiosyncrasy ? 

A peculiar or abnormal response to the action of 

a drug. 

For what conditions in the mouth is sulphuric acid 
useful ? In what strength and in what manner may it be 
employed ? 

In hypersensitive dentine, in simple cavities of 
decay, to open and enlarge minute root canals. In 
these cases it is employed in 50% strength, applied 
with a gold probe and neutralized with sodium bicar- 
bonate. In about 10% solutions, it may be employed 
as an aid to remove concretions upon roots. In this 
strength it may also be employed to remove dead 
bone. 

In what manner may the teeth be best protected 
from the effects of acids administered internally through 
the mouth ? 

They should be well diluted and an antacid at 
at once used to counteract any acidity induced 
through their use. 

What is a counter irritant ? Name two used in 
the mouth. 

A counter irritant is an agent used to excite 
vascularity where applied, resulting in the relief of 
pain and vascularity in other parts, e. g. Capsicum 
and tincture of iodine. 



THERAPEUTICS AND MA TERIA MEDIC A. 187 

What is the dose of tincture of aconite root ? 

One to three minims. 

What is the local action of aconite ? 

It acts as a powerful sedative, causing tingling 
and numbness due to paralysis of terminal nerve 
filaments. 

What preparation of arsenic is most used in dent- 
istry, and what is the local action of this preparation ? 

Arsenous acid in the form of a paste. 

When brought in contact with the tooth pulp we 
have congestion, accompanied by grumbling pain 
which in a few hours becomes acute and throbbing. 
The blood vessels become strangulated at the apex 
of the root, resulting in the death of the pulp, also in 
cessation of pain. 

What preparation of iron is particularly injurious 
to the teeth ? Why is it injurious ? 

Tincture of the chloride of iron. On account of 
the free acid it contains. 

Name the drugs that may be combined with 
arsenic for devitalizing a tooth pulp, and state what pur= 
poses these drugs serve. 

Combined with acetate or sulphate of morphine 
or hydro-chlorate of cocaine, as local anodynes, with 
an essential oil to make paste and facilitate the ap- 
plication as well as action. 

Name three local anesthetics used in dentistry, 
and state the conditions that call for their application. 

Cocaine hydrochlorate, carbolic acid, tincture of 



188 THERAPEUTICS AND MA TERIA MEDIC A. 

aconite. Cocaine hydrochlorate, for hypodermic use 
in extraction. Carbolic acid, where the sensibility of 
the gum is to be destroyed to permit of painless inci- 
sion being made. Tincture of aconite, to control pain 

by its application to the gum tissue in cases of peri- 
cementitis. 

What desirable qualities should a disinfectant pos= 
sess for use in a pulp canal ? 

Ability to neutralize various products resulting 
from putrefactive processes, and the attribute pene- 
trability. 

What conditions about the mouth call for the use 
of iodine, and what are its effects ? 

In pericementitis, in oedema of cheeks or lips, 
as an aid in removing green stain from the surfaces of 
teeth. Acts as a counter irritant and stimulates ab- 
sorption of effusions. 

What conditions about the mouth call for the use 
of carbolic acid, and what are its effects ? 

Full strength acts as a caustic and ma}^ be used 
to touch ulcers of gum tissue that has grown in a 
cavity. In a i% or 2% solution, as an astringent, 
antiseptic mouth wash in stomatitis. 

How should any injurious results arising from the 
local action of arsenic on the gums be treated ? 

Removing all necrotic tissue and touching with 
an iron preparation. 

Name the ingredients of a desirable dentifrice, 
and specify the properties that make each of these ingre= 
dients desirable. 



THERAPEUTICS AND MA TERIA MEDIC A, 189 

Precipitated chalk gives body and is antacid. 
Orris root gives desirable degree of coarseness. 
Pnlverized sugar improves the taste. 
Boric acid gives antiseptic property. 
Flavoring substance improves the odor and 
taste. 

Name two preparations of opium. State the dose 
of eaeh. 

Tincture of opium or laudanum. Dose 5 to 15 
minims . 

Camphoretted tincture of opium or paregoric. 
Dose 1 to 4 drachms. 

Of what drugs are morphine and atropine the 
alkaloids ? 

Opium and belladonna. 

Name a chemical antidote to bichloride of mer= 
cury ? 

Albumen. 

Name a physiologic antidote to cocaine. 

Morphine, whiskey, or nitrite of amyl. 

Name three different methods by which medi- 
cines may be administered ? 

By stomach, hypodermically, and through the 
rectum. 

For what is permanganate of potassium used in 
dentistry ? 

Ulcer of the mouth with offensive breath, ab- 
scesses, diseases of the antrum, necrosis and caries of 
bone. 



i go THERAPEUTICS AND MA TERIA MEDIC A. 

What are the dental uses of the essential oils ? 

To obtund hypersensitive dentine, to allay pain 
in an irritated pulp, to promote antisepsis in septic 
root canals and cavities. 

Describe the effect of aconite on the heart and 
name two other drugs which have a similar effect. 

Small doses decrease the force of ventricular 
contraction and slow the action of the heart. Large 
doses cause rapid weak action with tendency to stop 
in diastole. 

Veratrum viride and antimony have a similar 
effect. 

For what is amyl nitrite used, and how is it ad= 
ministered, and what is the dose ? 

Stimulant, particularly in cocaine poisoning. 
Usually administered by inhalation in three to five 
rninurn doses. 

What is the danger of using acids in the mouth ? 
What precaution should be taken ? 

They may cause disintegration of tooth struc- 
ture. They should be followed by antacid mouth 
washes 

For what is hydrogen peroxide used ? 

To destroy pus, to cleanse putrescent pulp 
canals, and whenever a germicide, deodorant or dis- 
infectant is required in the mouth. 

Name two escharotics, and state when escharotics 
should be used. 

Silver nitrate, carbolic acid. Escharotics are 



THERAPEUTICS AND MATERIA MEDICA- igi 

einplc^ed for the removal of hypertrophied gum tis- 
sue. To obtund hypersensitive dentine. In the 
treatment of ulcerative stomatitis, and to destroy pulp 
filaments in roots. 

riention three general and three local anesthetics. 

Nitrous oxide, ether and chloroform are general 
anesthetics. Hydrochlorate of cocaine, hydrochlorate 
of eucaine, and ethyl chloride are local anesthetics. 

What precautions should be observed in the ad= 
ministration of the general anesthetics ? 

Patients should not eat anything for several hours 
previous, should have bowels thoroughly evacuated, 
should be placed in a horizontal position, all foreign 
substances removed from the mouth, clothing loose 
around the neck and chest, a third party present if 
the patient be a female, and the anesthetic selected 
with reference to any organic disease of the patient. 
Development of dangerous symptoms should be 
watched for, and the anesthetic should not be given 
in an over dose. Resuscitating means should be at 
hand. 

Define hemostatic. Give three examples. 

Hemostatics are agents which stop hemorrhage 
by coagulating albumen and contracting the muscle 
fibres, e. g. tannic acid, tincture of iron, and nitrate 
of silver. 

ilention a medicine whose local action contracts 
the blood vessels of a part. 

Hydrochlorate of cocaine. 



192 THERAPEUTICS AND MA TERIA MEDIC A. 

flention a medicine whose local action dilates the 
blood vessels of the part. 

Hydrochlorate of eucaine. 

Differentiate disinfectant from antiseptic. Give 
illustrations of each. 

Disinfectants are agents which destroy the germs 
of disease. Antiseptics inhibit the growth of micro- 
organisms and neutralize the toxins, but do not neces- 
sarily kill the germs. 

Permanganate of potassium {2% solution), bi-' 
chloride of mercury (1-1000), peroxide of hydrogen 
are disinfectants. 

Boric acid and the essential oils in mild solution 
act as antiseptics. 

What is the objection to the use of iodoform ? 
Mention three drugs that may be used in place of iodo= 
form. 

Its very objectionable odor. Iodol, aristol and 
europhaen may be used in place of iodoform. 

What is meant by the cataphoric application of a 
remedy ? 

The use of a very mild current for the purpose 
of forcing the remedy into the dentinal tissues. 

What is the advantage of the cataphoric as com= 
pared with the ordinary local application ? 

The deeper layers of the dentine and the pulp it- 
self may be affected, whereas the ordinary application 
could not be made to affect these. 

What two medicines are particularly useful in 
cataphoric applications ? 



THERAPEUTICS AND MA TERIA MEDICA- igj 

Cocaine hydrochlorate to desensitize dentine and 
pulp, and 25% pyrozone for bleaching. 

Mention (a) three remedies for toothache caused 
by exposure of the pulp ; (b) two remedies for perice= 
mentitis. 

(a) Oil of cloves, oil of cinnamon, carbolic acid. 
(b) Tincture of aconite and tincture of iodine. 

flention a remedy that antagonizes the consti= 
tutional action of aconite. A remedy that increases the 
constitutional action of aconite. 

Opium antagonizes the constitutional action of 
aconite, and veratrum viride increases the constitu- 
tional action of aconite. 

flention the dose of two of the preparations of 
opium, and the dose of one of the alkaloids of opium. 

Tincture of opium, 10 to 15 minims; powdered 
opium, V 2 to 2 grains; sulphate of morphine, ^ to J^ 
grain. 

flention the dose of (a) potassium bromide, (b) 
chloral, (c) acetanilid. 

(a) Potassium bromide, 10 to 40 grains; (b) 
chloral hydrate, 5 to 15 grains; (c) acetanilid 1 to 5 
grains. 

Mention two heart stimulants that act rapidly, 
and give the dose of each. 

Aromatic spirits of ammonia 30-60 min. 
Ether 10-60 min. 

State the action of digitalis on (a) the heart, (b) 
the blood vessels, (c) the kidneys. 

(a) Increases the force of the heart contractions; 



1 9 4 THERAPEUTICS AND MA TERIA MEDIC A. 

lengthens diastole, decreasing the number of beats by 
stimulation of the pneumogastric. 

(b) Raises arterial tension by stimulating vaso- 
motor centre, by direct action on the musular coat 
and by increasing the force of the heart's contraction. 

(c) Dilatation of the renal arteries resulting in 
an increased flow of urine, without an irritating effect 
on the renal epithelium. 

What drug is often combined with morphia when 
given hypodermically ? Explain. 

Sulphate of atropine. Atropine being the physi- 
ological antagonist, it diminishes the danger of mor- 
phia poisoning. 

Which of the general anesthetics is most depress= 
ing to (a) the circulation, (b) the respiration ? i 

Chloroform to the circulation, and ether to the 
respiration. 

What is an astringent ? Mention three vegetable 
and two mineral astringents. 

An astringent is an agent that causes contrac- 
tion of tissue. Tannic acid, sumac, and haematoxy- 
lon are vegetable astringents. Silver nitrate and 
zinc sulphate are mineral astringents. 
What is an escharotic ? 

An agent that destroys organic tissue when in 
contact with it. 

Give the indications for the use in producing sleep 
of (a) morphine, (b) chloral, (c) potassium bromide. 

Morphine is used to induce sleep when the pa- 
tient is suffering great pain. Chloral is given where 



THERAPEUTICS AND MA TERIA MEDICA. i 95 

a patient is suffering from shock. Potassium bro- 
mide is given to allay nervous irritability, or as an 
aid to chloral hydrate. 

flention two medicines that increase blood pres= 
sure. 

Digitalis and strophanthus. 

Distinguish between a stimulant and an irritant. 

A stimulant produces increased functional activ- 
ity. An irritant exceeds the effect of a stimulant and 
induces venous hyperemia, and possibly inflammation. 
A stimulant acting continuously may become an ir- 
ritant. 

With what class of remedies are the coal tar pro= 
ducts prescribed for action on the heart? 

With cardiac stimulants. 

What is a sedative ? flention two sedatives. 

A sedative is an agent that lowers functional 
activity in a part. Aconite and gelsemium. 

What are the dental uses of the alkalies ? Men= 
tion two alkalies. 

To counteract any acid condition in the mouth, 
as in erosion or after acid medicaments. Lime, mag- 
nesium. 

What is the local action of chloroform when con= 
fined to a part so that evaporation is prevented ? 

Causes irritation resulting in the redness or even 
vesication with a sensation of heat followed by de- 
creased sensation of the part. 

What effect on blood pressure has (a) ether, (b) 
chloroform ? 



ip6 THERAPEUTICS AND MA TERIA MEDIC A. 

Ether increases blood pressure. Chloroform 
lowers blood pressure. 

State the dental uses of nitrate of silver. 

In the form of lunar caustic it may be used to 
destroy ulcers in the mouth, or to destroy hypersen- 
sitiveness of the dentine ; in about a 5 or even 10% 
solution, it is employed in gangrenous stomatitis. In 
50% solutions it has been recommended in the treat- 
ment of root canals. 

State with reference to formaldehyde (a) its dental 
uses, (b) the advantages of its use, (c) the objections to 
its use. 

In mild solutions, in association with other 
agents, as an antiseptic mouth wash ; in strong solu- 
tions about 5 to 10% of formalin it is used to disin- 
fect instruments. In the treatment of moist gangrene 
of the pulp, and wherever a powerful disinfectant is 
indicated without regard to its intensely irritating 
effect upon mucous surfaces. It is a powerful disin- 
fectant, and has a hardening effect upon disintegrated 
organic matter. It is intensely irritating to mucous 
surfaces. 

Differentiate a decoction, an infusion, and a 
tincture. 

Decoctions are prepared by boiling vegetable 
substances in water. Infusions are vegetable sub- 
stances treated with hot or cold water without boiling. 
A tincture is an alcoholic solution of a drug. 

State the conditions under which it is more advan- 
tageous to give medicines hypodermically than to admin= 
ister them internally. 



THERAPEUTICS AND MA TERIA MEDIC A. i 9 y 

When }^ou wish to produce a quick effect. When 
the patient cannot swallow, or is in a condition where 
absorption from the stomach would take place slowly. 

Mention one drug that contracts the pupil of the 
eye; one drug that dilates the pupil of the eye. 

Eserine contracts ; belladonna dilates. 

What remedies, general or local, aside from opera= 
tive procedure are useful for relief of toothache, when (a) 
pulp is alive and not exposed, (b) pericementitis has super= 
vened on the death of the pulp ? 

For pulp pain we may apply the essential oils, 
carbolic acid, or some of the strong alkaloidal pre- 
parations. For pericementitis we make applications 
of aconite and tincture of iodine. Internally, we 
give combinations of acetanilid and phenacetin ; and, 
in very severe cases, opium or chloral combined with 
ammonium bromide. 

State the reasons for or against the use of arse= 
nous acid to obtund sensitive dentine. 

It should not be used to obtund hypersensitive 
dentine, as it will devitalize the pulp. 

Mention the contraindications of chloroform anes= 
thesia. 

Chloroform should not be used where the recum- 
bent position cannot be maintained, or in any serious 
form of cardiac lesion. 

Describe the methods of administering cocaine to 
produce anesthesia. 

Anesthesia of the dentine and pulp may be in- 
duced by 10% or 15% solution of cocaine, forced into 



ig8 THE RAPE UTICS A ND MA TERIA MEDIC A. 

these tissues by pressure, or trie cataphoric current. 

Hypodermic injections are made with a i or 2% solu- 
tion for purposes of extraction. 

Of what is each of the following an alkaloid (a) 
strychnine, (b) atropine, (c) morphine. State the dose 
of each. 

(a) Nux vomica, (b) belladonna, (c) opium. 

Strychnia, fo- 2 T gr.; atropine, t x so -'f s gr.; mor- 
phia y*-y 2 gr. 

What property of tincture of iodine makes it of 
value in pericementitis ? 

Its counterirritating property, and its ability to 
stimulate the lymphatics to absorb inflammatory pro- 
ducts. 

In what position should the patient be during the 
administration of chloroform ? Why ? 

In the recumbent position, to allow of the easy 
flow of blood to the heart, to counteract the paralyz- 
ing influences of chloroform upon the circulation. 

Name four properties that a dentifrice should 
possess. 

Alkalinity, antiseptic property, sufiiciently coarse 
to be cleansing, and agreeableness to taste. 
What is an antiphlogistic? 

Any therapeutic means of combating the heat 
of inflammatory reactions. 

What is an escharotic ? 

An agent which devitalizes the tissue upon which 
it acts, producing an eschar or slough. 



THERAPEUTICS AND MATERIA MEDIC A. ig 9 

Name a condition about the mouth calling for the 
use of an escharotic. Name the escharotic best suited for 
the purpose. 

In ulcerative stomatitis nitrate of silver is em- 
ployed with most satisfactory results. 

What medicaments are useful in the local treat= 
ment of pyorrhea alveolaris, and what is accomplished by 
them ? 

Peroxide of hydrogen to destroy pus, and the 
pus forming organisms. Sulphuric acid dilute, or 
lactic acid concentrated for aids in removal of concre- 
tions upon roots. Trichloracetic acid in about 10% 
or even 20% solution, as a powerful antiseptic and 
astringent application in pockets. 

Define anesthetics, narcotics and sedatives and 
give an example of each. 

Anesthetics are agents that are capable of over- 
whelming the nervous centres, thus interfering with 
perceptions of pain, as ether or chloroform. Narcotics 
are agents that stimulate and stupefy the brain, allay 
pain and induce sleep, as opium. Sedatives are agents 
that depress the nervous centres and allay their ir- 
ritability or excitability, as bromide of potassium. 

Describe what is meant by an aqueous solution, 
and write a prescription, giving example. 

An aqueous solution is a drug held in a solution 
of water. 

Jfy Acidi Tannici, gr. x 

Aquae, f§ j 



200 THE RAPE UTICS A ND MA TERIA MEDIC A. 

Give rule for finding the amount of a drug in a 
given percentage of solution, with example. 

4% grs. to i oz. of solution being a 1% solu- 
tion, therefore, if we have the percentage we multiply 
it by 4J/2 , and the result is the amount of the drug in 
the given percentage. If we speak of a 5% solution 
we know that approximately we have 4% times 5, or 
22% grs. for every oz. 

Differentiate fixed oils and volatile oils, and give 
three examples of each. 

The fixed oils are compounds of carbon, hydro- 
gen and oxygen; the volatile oils are composed of car- 
bon and hydrogen. Among the fixed oils we have 
castor oil, almond oil, olive oil. Of the volatile oils 
we have cloves, cinnamon, peppermint. 

What is hydrogen dioxide ? Give its formula and 
dental use?. 

Certain volumes of oxygen mechanical ly held in 
water, H 2 2 . Hydrogen dioxide is used to de- 
stroy pus in alveolar abscess, or pyorrhea pockets, to 
cleanse putrescent root canals, and wherever a non- 
toxic disinfectant is indicated. 

What is arsenous acid ? Give medical properties 
and special dental use and antidote, 

Trioxide of arsenic. Internally, in small doses, 
it acts as an alterative tonic, promoting appetite and 
digestion, stimulating respiration and circulation, and 
increasing mental faculties. In dentistry, it is em- 
ployed to devitalize the pulp. The antidote in cases 
of poisoning is freshly prepared hydrated ferric 
oxide. 



THE RAPE [/TICS AND MA TERIA MEDIC A . 201 

What is iodoform ? Give a solvent and dental 
uses. 

Iodoform is the result of the action of iodine on 
alcohol and potassium hydroxid; the symbol being 
CHI 3 . Alcohol is a solvent. In dentistry, it is mostly 
employed as a filling in pulpless canals and in the form 
of iodoform gauze for packing wounds, but its odor is 
a serious objection to its employment. 

Give the medical properties and dose ; when indi= 
cated in dental practice, and how used ; toxic effects, if 
any; antidotal treatment of each of the following: — Aco= 
nite, quinine, naphthol, creasote, oil of cloves. 

Aconite locally paralyzes the terminal sensory 
filaments, causing numbness and loss of sensibility. 
Internally, in small doses it depresses respiration and 
circulation, and in large doses it paralyzes the heart's 
action. In dental practice it may be used locally to 
stop pain from an irritated pulp, or as a sedative ap- 
plied over the gum in pericementitis. Opium, or an}^ 
cardiac stimulant, together with artificial respiration 
are used in cases of poisoning. The dose is 1-3 min- 
ims of the tincture. 

Quinine is a tonic, antiseptic, antipyretic and 
antiperiodic. It interferes with the functions of 
the red blood corpuscles and arrests the movements 
of the white. In small doses it stimulates the brain; 
in large doses, it produces cerebral anemia, ringing in 
the ears, headache, delirium and coma. The tonic 
dose is 2 grs.,the antipyretic 5-10 grs., and the anti- 
periodic 10-20 grs. Morphine antagonizes its cere- 
bral action. Atropine its cardiac and antipyretic ef- 



202 THERA PE UTICS A ND MA TERIA MEDIC A* 

fects. Its use in dentistry is indicated when a patient 
gives evidence of septic fever through absorption of 
septic products in cases of acute septic pericementitis 
or alveolar abscess; in combination with acetanilid 
and salol, two grains of the sulphate of quinine given 
every two or three hours will have a controlling 
effect. 

Naphthol is a derivative of naphthalin, and has 
marked antiseptic properties. In dentistry it is used 
as hydronaphthol, a powerful antiseptic in 1-200 
solution. 

Creasote locally acts as an escharotic. Internally 
in small doses, its action is similar to carbolic acid. It 
is eliminated by the bronchial mucous membrane, 
which it stimulates, producing the effects of an ex- 
pectorant. It is sedative to the mucous membrane of 
the stomach. In dentistry, it is indicated wherever 
carbolic acid is used, although the latter is favored 
because it has not the intensely disagreeable odor of 
creasote. Dose 1-3 minims in oil. 

Oil of cloves belongs to a group of aromatic oils 
that possess many properties, in general. They are 
antiseptics, stimulants, and local anesthetics. Dose 
1-5 minims. In dentistry, it is used generally to 
allay pain in an aching pulp. 

What is formaldehyde ? State dental uses and 
strength of solution that should be used for each purpose. 

It is prepared by burning methylic alcohol in 
the presence of oxygen forming an oxide. It is used 
in the mouth as an antiseptic in % of one % solu- 



THERAPEUTICS AND MA TERIA MEDICA 203 

tion. In gangrenous pulp canals it is used in about 
10% solutions. 

Write two complete prescriptions, one containing a 
drug in aqueous solution, and the other containing a drug 
insoluble in water, also in solution. 

1^ Plumbi acetatis, gr. v. 

Aquae dist., f5j. 

]jk Hydronaphthol, 5j- 

Alcohol, f"5j. 

Sig. Teaspoonful in wineglass of water. 

Name three drugs useful in the treatment of em= 
pyema of antrum, and write a prescription containing one 
such drug in solution. 

Hydrogen dioxide, chloride of zinc, hydrona- 
phthol. 

1^ Hydronaphthol, 5j- 
Alcohol. fjj. 

Sig. Teaspoonful in wineglass of water. 

Name three heart stimulants administered hypo= 
dermically in the order of their rapidity of action. State 
dose of each. 

Alcohol, strychnia, digitalis. 
.Alcohol (whiskey), 30-60 min. 
Strychnia sulphate, 60-20 gr. 
Digitalis (tincture), 5-10 minims. 

Name two drugs useful in failure of respiration 
under anesthesia, state dose, and how administered. 

Strychnine, 2 Z Q gr., and atropine, ^ gr. Adminis- 
tered hypodermically. 

Define styptic, irritant and astringent, and give 
an example of each. 

A styptic is an agent applied locally to check 



204- THERAPEUTICS AND MA TERIA MEDICA. 

hemorrhage, like tannic acid. An irritant is an 
agent capable of drawing an excess of blood to the 
part upon which it is acting, like iodine. An astrin- 
gent causes contraction of living tissue, e. g. 
krameria. 

Name two drugs that are physiologically incom= 
patible, and two that are chemically incompatible. 

Aconite and morphine ; belladonna and opium, 
are physiologically incompatible. Tannic acid and 
iron ; sulphuric acid and lime, are chemically incom- 
patible. 

Give the dental uses of oil of cinnamon, silver 
nitrate, aconite, capsicum. 

Oil of cinnamon is used to allay an irritated 
pulp, or as an antiseptic application in root canals. 
Silver nitrate may be used in the form of lunar caus- 
tic to touch ulcers appearing in the mouth, or in full 
strength to obtund hypersensitive dentine. It has 
also been recommended, in 50% solution, in the treat- 
ment of pulpless canals. Tincture of aconite is used 
as a sedative application in pericementitis ; also, to 
control an aching pulp, and as an ingredient of oint- 
ments in neuralgia. Capsicum is used as an irritant 
in pericementitis, and as a stimulating ingredient in 
mouth washes in relaxed conditions of the mucous 
membrane. 

What are fluid extracts ? 

Alcoholic solutions, one minim representing one 
grain of the crude drug. 

How is the muscular system affected in complete 
anesthesia under ether and under nitrous oxide ? 



THERAPEUTICS AND MA TERIA MEDIC A. 2oj 

Under ether the muscles are relaxed. Under 
nitrous oxide the muscles are contracted. 

What are the advantages and disadvantages in 
the use of chloroform as an anesthetic in tooth extraction ? 
State symptoms of danger and treatment in case of 
collapse. 

The anesthesia resulting from inhalations of 
chloroform is prolonged, affording free opportunity 
for the removal of any number of teeth. The disad- 
vantages are decided. The upright position is against 
the patient; and, furthermore, failure of the heart's ac- 
tion is apt to result in consequence of the irritation 
of the puenmogastric induced through irritation of the 
fifth pair of nerves in the extraction. Symptoms 
of danger under chloroform are generally in relation 
to the heart's action. Failure of respiration would in- 
dicate danger, or sudden dilatation of the pupil of the 
eye. In collapse, raise the lower extremities and 
give an injection of strychnia and atropine. Emplo}^ 
artificial respiration, and warm applications to the 
body. 

What is ethyl chlorfde ? Describe method of pro= 
ducing local anesthesia by its use, and state precau- 
tions to be observed. 

Ethyl chloride is a volatile substance with a 
boiling point of about 60 ° F. When a spray is 
directed against tissue it acts as a freezing mixture 
by its very rapid volatilization. The tissue not to be 
affected should be protected against the spray. By 
the use of cold applications the tissue may be pre- 
vented from too quickly returning to a normal state, 



206 THE RAPE UTICS A ND MA TERIA MEDIC A. 

and thus lessen the incident pain which is usually 

felt after the use of chloride of ethyl. 

Describe the three stages of anesthesia under 
ether. 

In the first stage we have irritation in the fauces 
and coughing, followed by the second stage of cerebral 
intoxication, followed by the third stage of anesthe- 
sia, in which the face is usually flushed, full and regu- 
lar breathing, reflexes of the eye abolished, and 
muscles completely relaxed. 

Give the physiological action of nitrous oxide. 

It is a stimulating narcotic and anesthetic, with 

asphyxiating features. 

Give the precautions to be observed before and 
during the administration of nitrous oxide. 

The patient should be examined as to physical 
condition, and also as to what teeth or roots are to be 
extracted, so that no time is lost later. Care should 
be taken that sufficient nitrous oxide is at hand for the 
operation, and a third party should be present. The 
jaws should be kept separated. During the admin- 
istration, the respiration should be carefully watched. 
Interference with respiration is the chief source of dan- 
ger. As soon as the anesthetic state is induced, further 
administration should at once cease. 

Describe fully two methods for producing local 
anesthesia. 

Hypodermically, with a \% or 2%solution of 
cocaine hydrochlorate, injecting about 20 minims of 
the \% or 10 minims of the 2% solution about the 
alveolar tissue; or by means of a spray of ethyl chlor- 
ide, protecting the tissues not to be affected. The 



THERAPEUTICS AND MATERIA MEDIC A. 207 

spray is directed until the tissues whiten. It is also 
better not to allow of a too rapid return to normal con- 
dition of the anesthetized parts. This may be pro- 
duced by directing the patient to hold cold water in 
the mouth. 

Give conditions in which anesthesia is contra= 
indicated. 

When the patient is suffering from shock after 
an accident, and in serious organic cardiac lesions, 
like fatty degeneration or dilatation; or, where seri- 
ous interference with respiration is noted. Patients 
suffering from renal diseases, should not be given 
ether. 

Describe methods of procedure and precautions 
necessary in hypodermic injections for producing local 
anesthesia. 

The parts to be operated upon should be treated 
antiseptically, so that no adherent septic matter is 
carried into the subtissues. The needle should be as 
clean as it is possible to make it. Care should be 
taken not to penetrate a blood vessel. After injection 
the fluid should not be allowed to escape. The proper 
quantity and no more should be injected. 

How is anesthesia modified by age, sex and tem= 
perament ? 

In children we find a ready response to the in- 
halation of anesthetics. When ether is used, a hy- 
persensitive mucous surface in the pharynx and larynx 
induces coughing; in the aged, chronic bronchial irri- 
tation is apt to produce the same result. Women are 



208 THE RAPE UTICS AND MA TERIA MEDIC A. 

apt to give manifestations of hysterical tendencies. 
Sex and temperament may influence the amount nec- 
essary to induce anesthesia. The stage of excite- 
ment may be prolonged in hysterical subjects, and 
also in those of bilious attributes. 

What anesthetic do you prefer, and for what 
reason ? 

For the extraction of teeth and minor operations 
in the mouth that require little time for their execu- 
tion, nitrous oxide is the safest anesthetic we have at 
the present time. From a most extended experience 
during which hundreds of thousands of patients have 
been placed under its influence, the death rate is prac- 
tically nil. 

Mention some of the organic lesions which contra* 
indicate the administration of anesthetics. 

Fatty degeneration, dilatation and valvular 
diseases of the heart. In patients with tendency to 
apoplexy. Renal complications. Serious interferences 
with respiration. These conditions either set aside 
the use of anesthetics, or make their use dangerous. 

flention the differences between cocaine and 
eucaine. 

Cocaine is an alkaloid, soluble to the extent of 
over 30% in water, disintegrates upon boiling, and 
frequently is followed by poisonous symptoms. Eu- 
caine is synthetically prepared; is soluble to the extent 
only of about 4% in water, does not disintegrate when 
subjected to heat, and its use is not so frequently fol- 
lowed by dangerous symptoms. 



THE RAPE UTICS AND MA TERIA MEDIC A. 209 

At what period in nitrous oxide anesthesia may 
you have failure in circulation ? 

After the anesthetic stage, owing to the anemia 
of the brain. 

What causes the darkened appearance of the pa= 
tient under nitrous oxide, and state in what manner this 
may be lessened. 

The accumulation of carbon dioxide. Giving 
oxygen in combination with nitrous oxide will con- 
siderably lessen the bluish appearance of the coun- 
tenance. 

From what is nitrous oxide prepared ? 

From nitrate of ammonium, effecting its decom- 
position through heat. 

What is liquid nitrous oxide ? 

The gas nitrous oxide liquefies when subjected 
to a pressure of about 700 pounds at a temperature of 
about 45 F. 

From what is ether prepared ? 

Through the action of sulphuric acid upon ethy- 
lic alcohol. 

What is the appearance of the face under ether an= 
esthesia ? What is its effect upon the muscular system ? 

Generally flushed. It causes relaxation of the 
muscular system. 

What appliances should be at hand and in readi- 
ness when anesthetics are used ? 

Hypodermic syringe, with various respiratory and 
circulatory stimulants. Also the facility to perform 
artificial respiration. 



210 THERAPEUTICS AND MA TERIA MEDIC A. 

What is bromide of ethyl ? 

An anesthetic agent prepared from bromide of 
potassium, sulphuric acid and ethylic alcohol. 

How is it administered, and what is its action ? 

The quantity to be administered is poured out 
upon a towel (about 2 drachms) and inhaled by the 
patient. Bromide of ethyl resembles chloroform in 
its action upon the heart. It interferes with the 
function of the red corpuscles, and affects conscious- 
ness last ; in many cases patients are conscious and 
yet not perceptive of any pain. The anesthesia 
generally lasts about five minutes. 

What strength of solution of cocaine would you 
employ for hypodermic use, and how much of the solution 
would you use ? 

Generally 1% or 2% solution is employed. 20 
minims of the 1%, or about 10 minims of the 2% solu- 
tion may be injected. 

Give the antidote of the following drugs, (a) 
iodine, (b) bichloride of mercury, (c) arsenic, (d) phos= 
phorus. 

(a) Starch, (b) albumen, (c) hydrated ferric 
oxide (freshly prepared), (d) turpentine. 

Mention two drugs insoluble in water. 

Bismuth, chloride of mercury (mild). 

What alkaloids are found in opium ? What is its 
active principle ? 

Morphine, codein, narcotine, thebaine. 

The active principle is morphine. 



THE RAPE UTICS A ND MA TERIA MEDIC A. 211 

What is meant by a mydriatic ? Name one. 

A mydriatic is an agent which causes dilatation of 
the pupil of the eye, e. g. belladonna. 

What is meant by a synergist ? Name the syner- 
gists of aconite. 

A synergist signifies an aid. Veratrum viride, 
tartar emetic or bromide of potassium act as syn- 
ergists to aconite. 

What is a cathartic, and how are cathartics 
divided ? 

Cathartics are agents which produce evacuation 
from the intestinal tract. They may be arranged 
according to the severity of the effect. Laxatives are 
the mildest, purgatives are more severe, and drastics 
most severe in their action. 

Give the treatment of poisoning from cocaine. 

Fresh air, inhalations of nitrite of amyl or am- 
monia. Alcohol, (brandy or whiskey), aromatic 
spirits of ammonia, strychnine, digitalis and atro- 
pine, hypodermically or by the mouth. External 
heat. 

State the local action of cocaine on the blood 
vessels. 

Cocaine applied to a mucous membrane or in- 
jected under the skin causes the blood vessels of the 
part to contract. As the effect passes off, the reaction 
results in dilatation. 

Name three mineral acids employed in dentistry 
and give their properties and uses of each. 



212 THERAPEUTICS AND MA TERIA MEDIC A. 

Hydrochloric acid. — The strong acid is a power- 
ful caustic and escharotic ; also disinfectant and furni- 
gant. The dilute acid is tonic, refrigerant and 
astringent. 

The strong acid is employed as a local applica- 
tion in gangrenous stomatitis, or cancrum oris, for 
arresting the ulcerative process. Combined with 
equal parts of glycerine it is useful in inflammation 
and ulceration of the oral mucous membrane ; also in 
cases of sloughing. In aphthous ulceration of the 
mouths of children, it is often useful. 

Nitric Acid. — Pure nitric acid is a powerful caus- 
tic and escharotic. The dilute acid is an antalkaline, 
alterative tonic and refrigerant. 

The strong acid, when mixed with two parts of 
hydrochloric acid, is solvent for gold. It is employed 
as a caustic in cancrum oris ; also for malignant 
ulcers of the mouth and for devitalizing pulp of 
teeth when nearly exposed by mechanical abrasion. 

Sulphuric acid. — The strong acid is a powerful 
escharotic, the dilute acid is refrigerant, astringent 
and tonic. The concentrated sulphuric acid is used 
as a caustic in malignant ulcers, cancrum oris and 
gangrene in the form of a paste, made by mixing it 
with powdered sulphate of zinc. It is also used to 
cleanse metal plates. The dilute acid or the aromatic 
sulphuric acid which is more agreeable is used in 
pyorrhoea alveolaris, and in caries and necrosis of the 
maxillary bones, as an injection or lotion. It is also 
employed in cases of recession of the gums and ab- 



THERAPEUTICS AND MATERIA MEDIC A- 2i 3 

sorption of the processes. It is valuable in alveolar 
abscesses as an injection. It is employed in stoma- 
titis and ulcers of the mouth. 

Mention (a) two heart stimulants, (b) two heart 
sedatives. State the dose of each. 

(A) Aromatic Spirits of Ammonia, 20 minims to 
1 drachm. Whiskey, 2 drachms to 1 ounce. 

(B) Tincture of aconite, 1 to 5 minims. 
Tincture of veratrum viride, 3 to 30 minims. 

Mention three medicines used to produce emesis 
and state how each is administered. 

Sulphate of zinc, 10-30 grs. by mouth. 

Sulphate of copper, 2-4 grs. by mouth. 

Apomorphine hydrochlorate, le-^i g r - hypo- 
dermically. 

flention three medicines used to produce diapho- 
resis. 

Pilocarpine, tartar emetic and Dover's powder. 
What is the local action of chloroform ? 

Placed on the skin and allowed to evaporate it 
produces a sensation of cold. If the vapor be con- 
fined it causes irritation with redness and even vesi- 
cation accompanied by a sensation of heat followed 
by numbness and a decreased sensation of the part. 

Define materia medica, therapeutics. 

Materia medica treats of the source of drugs, 
their physical and chemical properties and may also 
include their physiological action. 



2i 4 THE RAPE UTICS AND MA TERIA MED/CA. 

Therapeutics treats of the application of remedial 
agents to disease. 

In what ways may medicines enter the system ? 

Mouth, rectum, respiratory tract, absorbed 
through the skin and injected under the skin. 

What is the difference in the source of carbolic 
acid and creosote ? 

Carbolic acid is obtained during the distillation 
of coal tar. Creosote is obtained during the distilla- 
tion of wood tar. 

Name two drugs whose poisonous action is mark= 
edly manifest in the mouth. Give the distinguishing 
characteristics of the effects of these drugs. 

Iodides and mercury. 

Iodism is manifest by swelling and redness of 
the gums, fauces hard and soft palate, foulness of the 
tongue, fetid breath, and increase of mucus in the 
mouth; also headache, coryza and increased bron- 
chial secretion. Mercury may increase the salivary 
flow to several pints per day. At first the secretion 
is thick but later becomes thin. Fetid breath, sore 
gums may go on to ulceration of the mouth and 
cheeks. Low fever. 

Which of the vital organs fails first in collapse 
from (a) ether, (b) chloroform ? 

(a) Kills by paralysis of respiratory center (b) 
usually the heart, but may be respiratory center. 

Name two medicines that decrease blood pressure. 

Tartar emetic and tincture of aconite. 



THERAPEUTICS AND MA TERIA MEDIC A. 21 5 

Describe the method of administering a medicine 
by which its quickest action is obtained. 

The medicine in solution is placed in a hypoder- 
mic syringe (the syringe and solution being as near 
aseptic as possible). The air is expelled while the 
needle points upward, sterilize the skin and inject con- 
tents into the cellular tissue. 

Define diuretic, diaphoretic, expectorant. 

Diuretics are agents which increase the flow of 
urine. Diaphoretics increase the perspiration. Ex- 
pectorants increase and modify the secretion of the 
bronchial mucous membrane. 

Differentiate a tonic and a stimulant. 

Tonics promote secretion and give tone to the s} T s- 
tem. 

Stimulants increase the function of the part or 
organ. 

Mention two medicines that may be used as 
cauteries. 

Nitrate of silver and carbolic acid. 

State the treatment of carbolic acid poisoning. 

Administer a soluble sulphate (sodium or mag- 
nesium) and follow by albumen and mucilaginous 
drinks. Wash out the stomach. Combat collapse 
by external heat and with hypodermic injections of 
strychnine and atropine. 
What is an emetic ? 

Emetics are agents which excite vomiting either 
by local or central action. 



216 THERA PE UTICS A VD MA TERIA MEDIC A* 

flention two drugs that reduce fever. 

Acetanilid. Quinine. 
What is an analgesic ? 

An agent which relieves pain. This may be 
accomplished either by local or central action. 

Describe the symptoms of cocaine poisoning. 

A rapid feeble and irregular pulse, with shallow 
and labored respiration, clammy skin, dilated pupils, 
delirium and hallucinations. May have clonic con- 
vulsions and increased temperature. 

What restoratives are most desirable in case of 
threatened collapse during the administration of (a) Ni= 
trous Oxide, (b) Ether, (c) Chloroform. 

(a) Amyl nitrite, oxygen, atropine. 

(b) Ammonia, oxygen, strychnine, atropine 
and farradic current. 

(c) Ammonia, strychnine and digitalis. 

What is the antidote for opium ? 

Potassium permanganate (chemical). Atropine 
(physiological). 

What is the dose of bichloride of mercury ? Give 
its antidote. 

(kr-il gr. Antidote, albumen. 

flention two purposes for which medicines may be 
applied cataphorically in dentistry. 

For painless tooth extraction, and to antisep- 
ticize pulp canals. 



THERAPEUTICS AND MATERIA MEDIC A. 21 7 

What medicines are indicated and about how 
long should they be applied cataphorically for the purposes 
mentioned in the preceding question. 

(a) Cocaine, (b) Silver Nitrate, 8-20 minutes. 

Hention three saline cathartics and state the dose 
of each. 

Sulphate of magnesia (Epsum salt), 1 drachm to 
iY 2 ounces. 

Tartrate of Potassium and Sodium (Rochelle 
salt), 1 drachm to 1 ounce. 

Solution of Citrate of Magnesia, 12 ounces. 
Distinguish between narcotics and hypnotics. 

Narcotics stupefy and weaken vital actions. 
Hypnotics produce sleep. 

Mention three good counterirritants. 

Cantharides, croton oil, and mustard. 

Define chemical antidote for a poison, physiologi= 
cal antidote for a poison. 

By chemical antidote is meant some substance 
which combines chemically with the poison produc- 
ing an inert or insoluble compound. By physiologi- 
cal antidote is meant a substance which is opposed to 
the poison in its action on the economy. 

Mention the source of carbolic acid. State three 
properties of carbolic acid. 

Coal tar. Local anesthetic, caustic and antiseptic. 
Name the antacids valuable for use in the mouth. 



218 THERAPEUTICS AND MA TERIA MEDICA, 

Sodium bicarbonate, lime water, chalk and char- 
coal. 

What is the chief use of capsicum in dentistry ? 

As tincture or plaster in periodontitis. 

Name a condition about the mouth calling for the 
use of an escharotic. Name the escharotic best suited for 
the purpose. 

Cancrnm Oris. Carbolic Acid. 

What is meant by chemical and physiological in= 
compatibility of medicines ? 

Agents are said to be chemically incompatible 
when their mixture results in the decomposition of one 
or more of the ingredients. 

Physiological incompatibility is where one drug 
produces effects upon the system opposite to the action 
of some other drug, like aconite and opium. 

Give the physiological action of belladonna. 

Belladonna is an anodyne, an anti-spasmodic, a 
mydriatic, an irritant narcotic ; in small doses a resp- 
iratory, cardiac, and spinal stimulant; in large doses 
a paralyser of the secretory and motor nerve endings, 
and a stimulant of the sympathetic system. It pro- 
duces dryness of the mucous membranes of the nose, 
mouth, throat and larynx; and at first lessens the 

gastric and intestinal secretions, but soon reproduces 
them in large quantity. The heart-rate is at first 

slowed, but soon becomes vigorous and rapid. 

Give the mouth signs of mercurial poisoning. 



THE RAPE UTICS A ND MA TERIA MEDIC A, 219 

Hyperemic mucous surface, teeth tender upon 
pressure and loose, increased flow of saliva, swollen 
tongue, and metallic taste. 

How should the administration of chloroform dif- 
fer from that of ether ? 

Chloroform should be administered a few drops 
at a time and the vapor allowed to mix freely with 
air while ether is administered in larger quantities 
and only a small amount of air allowed to mix with 
the vapor. 

flention the contraindications of ether anes- 
thesia. 

In cases where interference with respiration ex- 
ists. In affections of the kidneys. In plethoric indi- 
viduals with tendency to apoplexy. In abdominal 
operation where subsequent wretching or coughing 
would disturb the womb. 

State the objection to the use of iron salts, as 
styptics. 

The clot which is formed is soluble in the 
fluids of the mouth, frequently resulting in secondary 
hemorrhage. 

What drug is given hypodermically to produce 
emesis ? State the dose of this drug. 

Hydrochlorate of apomorphine, ^ to \ of a grain. 

flention, with doses, three coal tar preparations, 
useful in the treatment of neuralgia. 

Acetanilid, 2-5 grs.; phenacetin, 2-5 grains; an- 
tipyrine, 5-10 grs. 



220 THERAPEUTICS AND MA TERIA MEDIC A. 

Differentiate poisoning by atropine and poisoning 
by strychnine. 

In atropine poisoning we have motor paralysis, 
delirium and death. In strychnine poisoning we have 
convulsive action of the muscles with consciousness. 

Mention three disinfectants suitable for use in pu= 
trescent root canals of teeth. 

Hydrogen dioxide, formalin, carbolic acid. 

What are the contraindications for the use of 
nitrous oxide ? 

In cases with marked interference with respira- 
tion. 

Write a prescription for an antiseptic mouth 
wash. 

R> Acidi carbolici (95%) mxxx. 

Aquae q. s. f.^v. 

Sig. Use as mouth wash. 

What is meant by the active principles of a drug ? 
Give an example. 

The extractive substance which gives the drug 
its medicinal properties. Quinine is an active prin- 
ciple of cinchona bark. 

Mention three alteratives. 

Arsenic, mercury and iodine. 

Give the physiological action of Ergot. 

Externally it acts as a slight astringent on the 
broken skin or mucous membrane. 

Gastro intestinal tract. — Disagreeble taste and 
may produce nausea and vomiting. 



THERAPEUTICS AND MATERIA MEDIC A- 221 

Circulation. — Heart-beat becomes slow and in- 
creased in force. It stimulates the vasomotor cen- 
tre and unstriped muscular fibres of arteries raising 
blood pressure. 

Uterus. — It stimulates the contraction of the 
parturient uterus, increasing the force and frequency. 
There is a marked decrease in the blood supply of 
the nonparturient uterus. 

Nervous system.— It causes anaemia of the cen- 
tres, particularly in the spinal cord. 

Give the physiological action of digatalis. 

Gastrointestinal tract. — Digitalis may cause 
nausea, vomiting and diarrhoea. 

Circulation — Decreases the number of heart 
beats, lengthening diastole (stimulation of inhibitory 
fibres of vagus). It increases the force of the con- 
tractions (intrinsic ganglia). Arterial tension rises 
from increased cardiac force, excitation of vasomotor 
centre, and direct action on the muscular coats of the 
arteries. 

Kidneys. — Followed by relaxation of renal ar- 
teries resulting in an increased flow of urine. Later 
the heart becomes weak and irregular, beating with 
increased frequency. Large doses decrease abnormal 
temperature. It may cause headache, vertigo or de- 
lirium. It also stimulates the uterine contractions. 

Give the physiological action of nux vomica 

Gastrointestinal tract.— Small doses act as a 
bitter tonic increasing appetite, secretion and diges- 



222 THERAPEUTICS AND MA TERIA MEDIC A . 

tion. It increases the muscular tone of the stomach 
and peristalsis is also increased. 

Circulation. — Cardiac centre, vaso motor centre 
and cardiac ganglia are stimulated raising arterial 
tension increasing the force of heart action but slow- 
ing its beat. The respiration centre is stimulated, 
the pupils dilate, the contractile power of the bladder 
is stimulated, the reflex activity of the spinal cord is 
increased. It also acts as an aphrodisiac. 

Give the physiological action of Opium. 

Externally it is slightly sedative. 

Stomach. — It decreases sensation, secretion and 
peristalsis, reducing hunger and pain. Continued use 
deranges digestion. 

Intestines. — Sedative action, relieving pain, se- 
cretion decreased and peristalsis is decreased by stimu- 
lation of the splanchnics (inhibitory nerves.) Large 
doses may cause diarrhoea leading to paralysis of 
the splanchnics. Bile and pancreatic juice are de- 
creased. 

Nervous System. — The convolutions of the brain 
are briefly excited, then depressed by direct action 
on nerve cells (possibly by causing anemia). 

Stage of Excitement. — Exaltation of feelings, 
happiness, brilliancy of imagination, increase of in- 
tellectual power and mental vigor. Imagination 
becomes extravagant, dreams of grotesque and im- 
possible things. Sensory and perceptive centres be- 
come depressed, stupor and sleep. Pupil of the eye 
is contracted. 



THERA PE [/TICS A ND MA TERIA MEDIC A . 223 

Spinal Cord.— Reflex activity is increased due to 
stimulation of centres, followed Ity depression and 
decreased reflexes. 

Medulla. --The respiratory centre is slightly 
stimulated then depressed, respiration becoming slow; 
it kills by paralysis of respiratory centre. 

The cardiac centre is stimulated and the heart 
beats slowly and strongly, depression being late. 
The sensory nerve endings are depressed. 

Give the toxic symptoms of opium. 

Coma from which the patient cannot be aroused. 
The reflexes are abolished, skin moist and cyanotic, 
pulse weak, respiration slow and labored (five to six 
in a minute) pupils contracted (pin point) but may 
dilate just before death. Muscles are relaxed. Death 
is caused by paralysis of the respiratory centre. 

Give the toxic symptoms of nux vomica. 

The patient becomes restless with muscular 
twitching and a sensation of impending suffocation. 
Suddenly the patient is seized with a violent clonic 
convulsion which pervades the whole body (particu- 
larly the extensor muscles). The face is drawn, 
opisthotonos supervines, the eyes are prominent, 
pupils dilated, face is livid and congested, due to 
spasms of the- respiratory muscles. The intellect 
remains clear. The spasms are intermittent, lasting 
from one half to five minutes. Death results from 
accumulation of CO,. 



CHEMISTRY AND METALLURGY. 

What is water of crystallization ? 

Water of crystallization is such water in solid 
form as gives to a substance its crystalline shape and 
frequently its color. 

Give two methods of obtaining hydrogen ? 

(i) By the action of zinc on sulphuric acid. 

(2) By the electrolytic decomposition of water. 

What conditions are essential for the perfect weld= 
ing of metals, whether hot or cold ? 

Perfect cleanliness. 

Freedom from oxidation. 

Application of considerable compressing force. 

Selection of the proper metals. 

Give the chemical formula of bicarbonate of 
soda. 

NaHC0 3 

What chemical change occurs in the action of 
H 2 2 as a germicide or antiseptic? 

H, 2 is changed into water and nascent oxygen 

in contact with organic matter. 

What properties does platinum impart to its alloy 
with gold ? 

Elasticity. 

Greater strength. 

Greater hardness. 

It gives a white color. 

How would you distinguish a bar, or plate, of tin 
from a metal similar in appearance ? 



CHEMISTRY AND METALLURGY. 225 

By bending it, tin evolves a peculiar sound 

known as the - " tin cry." This is only evolved when 

the tin is quite pure. 

Name some of the purer forms of carbon as found 
in nature. 

Diamond and graphite. 

Define separately the terms Ductility, Mallea= 
bility and Volatility, and give examples of each. 

Ductility is that property of matter by virtue of 
which it may be drawn into wire, e. g. gold, silver, 
platinum. 

Malleability is that property of matter by virtue 
of which it may be hammered into sheets, e. g. gold, 
copper, and tin. 

Volatility is the readiness with which a metal 
passes into vapor with or without heat, e. g. mer- 
cury, zinc, tin. 

Give approximately the composition of Brass and 
German Silver. 

Copper 50 to 60 ] 

Zinc 20 to 30 y form German Silver. 

Nickel 10 to 20 J 

Brass is an alloy of zinc and copper ; the addi- 
tion of nickel forming German silver. 

In uniting platinum to platinum, what would you 
use as a solder, and why ? 

Gold, because it readily alloys with platinum, 
giving a strong, permanent union and a color like 
that of platinum. 

Place after each of the following metals, its chem= 
ical symbol : Gold, Platinum, Silver, Tin and Copper. 

Gold, Au.; Platinum, Pt; Silver, Ag.; Tin, Sn.; 
Copper, Cu. 



226 CHEMISTR Y AND ME TALL URGY. 

Describe the simplest test for Sodium and Potas= 
sium Salts in solution. 

Wet a clean platinum wire in trie solution and 
hold in the inner Bunsen flame ; the outer flarne 
would be colored yellow if sodium, and violet if potas- 
sium be present. It may be necessary to concentrate 
the solution. 

Give a chemical test for Silver in solution. 

The addition of hydrochloric acid, or a soluble 
chloride, produces a white precipitate of chloride of 
silver, soluble in ammonium hydrate, but insoluble 
in nitric acid. 

Give the formula of Acetic Acid, Oxalic Acid. 

Acetic Acid, HC 2 H 3 2 . 
Oxalic Acid, H 2 C,0 4 . 

Define the term Amalgam. 

Amalgam is an alloy of two or more metals, one 
of which is mercury. 

Describe the methods of tempering steel instru= 
ments. 

The instrument is placed in a sand bath and 
covered with sand, leaving a minute point exposed to 
the air ; heat is then gradually applied to the sand 
bath until the desired temperature of steel has been 
reached, which can be told by the color of the ex- 
posed part. The instrument is then cooled quickly, 
as by immersing in water, acids or other liquids. 
Various methods of heating are used as hot lead, 
alcohol lamp, open fire. 

What are the advantages of annealing alloys for 
dental amalgam ? Describe the process. 



CHE MIS TR Y AND MET AIL UR G V. 227 

To reduce brittleness. At times, to change the 
character of the alloy and to secure uniformity of the 
alloy. The substances are heated and then allowed 
to slowly cool, the process being the inverse of tem- 
pering. 

What elements constitute the chlorine group ? 
Are they metallic or nonmetallic ? 

Chlorine, Bromine, Iodine, Fluorine. 
Nonmetallic. 

Write the chemical formula for Potassium 
Iodide, Zinc Chloride and Calcium Sulphate. 

Potassium Iodide, KI. 
Zinc Chloride, Zn Cl 2 . 
Calcium Sulphate, CaS0 4 . 

What chemical changes result from the addition 
of Hydrochloric Acid to Silver Nitrate ? Answer by giving 
the equation. 

AgN03+HCl=AgCl f HNO3. 

Give two methods of obtaining oxygen. 

The oxides of the noble metals are by heat de- 
composed into the metal and oxygen. HgO+heat 

=Hg+0. 

Potassium chlorate, KCIO^, may be decomposed 
by heat into potassium chloride, KC1, and oxygen. 
KC10 3 +heat=KClH-30. 

What are the chemical and physical properties of 
asbestos ? 

Asbestos is a silicate of magnesium. It occurs 
in mineral deposits in silky like fibres and ma}' be 



228 CHE MIS TR Y AND ME TALL UR G Y. 

woven into cloth. It is not dissolved or affected by 
water, acids, or heat. 

Name four organic acids. 

Acetic, citric, lactic, butyric. 

What metals and alloys are used for dies and 
counter=dies ? State for which each is best adapted. 

Zinc ; Babbitts metal ; alloy of zinc and tin. 

Zinc ; lead. 

Babbitts metal is used where tissues covering 
hard palate are thick and spongy while alveolar ridge is 
hard and covered by a thin membrane. For other 
purposes zinc is better for dies. 

In counter-dies zinc is serviceable in working 
platinum-gold or iridium-platinum. 

For more perfectly swaging the metal to the 
die, zinc is also of great assistance in conforming 
plates to dies for partial dentures. For other pur- 
poses lead is used. 

Name five metals all of which can be manufac= 
tured into wire, sheets, or foil. 

Gold, platinum, silver, copper, tin. 

Name some'of the metals for which mercury pos= 
sesses a great affinity. 

Silver, tin, sodium. 

What are the principal differences between metal= 
lie and nonmetallic elements ? 

A metallic substance is solid at ordinary tem- 
peratures, with few exceptions. Has considerable 
weight and is more or less malleable, ductile and 



CHEMISTR Y AND METALL URGY. 229 

tenacious. It is opaque to light and is a good con- 
ductor of heat and electricity. It has a lustre, is 
electro-positive and forms bases with oxygen. It dis- 
places hydrogen from acids to form salts. 

Substances not possessing these characteristics 
are grouped as non-metals. 

Place the chemical formula after each of the fol- 
lowing acids : Sulphuric, Nitric, Hydrochloric. 

Sulphuric, H 2 S0 4 . 
Nitric, HNO3. 
Hydrochloric, HC1. 

How does plaster=of= Paris differ chemically from 
quick=lime ? 

Quick-lime is oxide of calcium, CaO. 
Plaster-of-Paris is dehydrated sulphate of calcium, 
3CaS0 4 . 2H 2 0. (Bloxhain). 

What constitutes the difference between a noble 
and a base metal ? Give examples of each. 

A noble metal is one whose oxide is decomposed 
at a temperature not higher than a red heat, e. g. 
platinum, mercury and gold. 

A base metal is one whose oxide requires tem- 
peratures higher than a red heat and the use of a 
reducing agent to decompose them, e. g. lead, copper, 
and iron. 

Mention the three only metals which are attracted 
by the magnet and which can themselves become 
magnets. 

Iron, nickel, and cobalt. 



2jo CHEMISTR Y AND METALL URGY. 

Give the chemical equation for the formation of 
water from its elements. 

2H 2+ 2 +Heat=:2H 2 0. 

What is the difference between deliquescence and 
efflorescence ? Give examples of each. 

Some solid substances have the power of absorb- 
ing moisture from the air which is called deliques- 
cence', and the property which certain crystallized 
substances have of loosing water of crystallization 
when exposed to the air is known as efflorescence. 
Calcium chloride and potassium hydroxide are exam- 
ples of the former, and ferrous sulphate and sodium 
carbonate are examples of the latter. 

What is aqua regia and its principal property ? 

Aqua regia is a mixture of water, nitrosyl chlor- 
ide and chlorine gas, obtained by adding nitric acid 
to hydrochloric acid. 

It is a solvent for gold and platinum. It is also 
used medicinally. 

What is CaS0 4 and what are its uses in dent= 
istry ? 

CaS0 4 containing water of constitution is 
gypsum. On being roasted it parts with a portion of 
its water forming Plaster-of-Paris. This latter sub- 
stance is used for taking impressions or models of the 
interior of the mouth. 

What does the term carat signify ? 

The term carat refers to the proportionate 
amount of pure gold in a gold alio}', e. g. Pure gold 



CHEMISTR Y AND METALL URGY. 231 

being 24 carat, 18 carat gold being 18 parts gold 
and 6 parts alloy, 

What do you know about Hg as a metal ? How 
are impurities detected and how readily removed ? 

Mercnry is the only metal liqnid at ordinary 
temperature, and resembles silver in appearance. 

Sp. Gr. 13.56. It does not tarnish in air and 
dissolves all metals except iron to form amalgams. 

A globule of Hg should be round. If it assumes 
an elongated shape or leaves a metallic mark as it 
passes over a smooth surface it is impure. To purify 
Hg distil it, or cover its surface with nitric acid and 
after 24 hours, decamp liquid and wash with water. 

Why cannot amalgam of aluminum and mercury 
be employed in filling cavities in teeth ? 

Because the formation of an aluminum amalgam 
is characterized by an exhibition of the affinity of 
aluminum for oxygen and its setting is attended by 
the evolution of great heat, expansion, oxidation of 
the instruments used, crackling of gas disengage- 
ment. 

Why do we find the quality of cohesiveness more 
marked in Gold than in Silver, Copper and Lead ? 

Because gold is of a closer texture than other 

metals. It does not oxidize directly and is probably 

not volatile. It has the power of welding when cold. 

How is hydrogen dioxide obtained and what is its 
formula? 

Formula, H 2 2 . 

Hydrogen dioxide is obtained by the decomposi- 
tion of barium dioxide by sulphuric acid, Ba Q 2 + 



2 3 2 CHE MIS TR Y AND MET ALL UR G Y. 

H 2 S0 4 = Ba S0 4 + H 2 2 . The H 2 2 thus ob- 
tained is not pure, but contains a considerable quan- 
tity of water which is necessary to affect the decom- 
position. From the aqueous solution we can produce 
a 50% solution by 'evaporation at a temperature not 
exceeding 140 F. If this is heated in vacuo at an 
increased temperature a nearly pure hydrogen dioxide 
is obtained by distillation at a temperature of 185 ° F. 

What is purple of cassius and how does it interest 
dentists ? 

Purple of cassius is a purple precipitate pro- 
duced by a mixture of stannous and stannic chlor- 
ides with gold chloride. It is used by manufacturers 
of porcelain teeth in obtaining the gum color. 

What are the chemical constituents of tooth 
enamel ? 

Salts of lime, the calcium phosphate being in 
excess while the calcium carbonate and calcium fluor- 
ide are in smaller quantities. 

Name some of the more malleable metals ? 

Gold, Silver, Tin, Copper, Cadmium, Platinum, 
Lead and Zinc. 

What is meant by specific gravity and how is it 
obtained ? 

Specific gravity, or specific weight, denotes the 
weight of a substance as compared with the weight of 
an equal bulk, or equal volume, of another substance, 
which is taken as a unit or standard. To find the 
specific gravity of a solid or liquid, divide the weight 
of the solid or liquid by the weight of an equal vol- 



CHE MIS TR Y AND ME TALL UR G Y. 233 

ume of water at 6o Q F. We may also find the spec- 
ific gravity of liquids by an instrument known as 
hydrometer; or, if made for some special purposes, 
as urinometers, alcoholometers, etc. The specific 
gravity of gases is determined by weighing the dried 
gas in a flask ; then exhausting the flask and filling 
it with dried hydrogen or air, and again weighing. 
If the temperature and pressure remain the same, 
divide the weight of the gas by the weight of air or 
hydrogen. 

Give the chemical formula for each of the following: 
Sulphate of Copper, Nitrate of Silver, Iodide of Potas= 
sium. 

Sulphate of Copper, CuS0 4 . 
Nitrate of Silver. AgN0 3 . 
Iodide of Potassium, KI. 

Write the equation for the reaction of Sulphuric 
Acid on common salt. 

2 Na CI + H 2 S0 4 = 2HCI + Na 2 S0 4 . 

Why are the salts of some metals called Sul= 
phides, Sulphites and Sulphates? 

Sulphides are binary compounds, one of the ele- 
ments being sulphur ; sulphates and sulphites are 
oxy-salts, the sulphates containing a relatively larger 
quantity of oxygen. 

What are the essential properties of an Acid ? 

(a) The hydrogen present is replaceable by 
metals, the compound formed being a salt. 

(b) They change the color of many organic sub- 
stances. Litmus is changed from blue to red. 



2 34 . CHEMISTR Y AND METALL URG Y. 

(c) They have (when soluble in water) an acid 
or sour taste. 

(d) It unites with and neutralizes the bases. 

(e) When concentrated it corrodes tissues. 

What are alkaloids? Name three. 

Alkaloids are active principles of organic sub- 
stances. They all contain nitrogen and are alkaline 
in reaction. Morphine, Strychnine, Quinine. 

By what principle do elements combine to form 
compounds ? 

In obedience to the laws governing chemical 
affinity. Electrical force plays an important part in 
the production of compounds. 

What is the compound of oxygen and another 
element called ? 

An oxide. 

What influence has temperature on a mixture of 
oxygen and hydrogen ? 

It produces an explosion with formation of water. 

How is muriatic acid prepared? Give the equa= 
tion. 

By roasting a mixture of sodium chloride and 
sulphur. NaCl+H a S0 4 =NaHS0 4 +HCL 

Give examples of analysis and synthesis. 

Heating mercuric oxide produces the metal mer- 
cury and the gas oxygen. (Analysis). 

Passing an electric spark through a mixture of 
equal volumes of hydrogen and chlorine produces 
hydrochloric acid. (Synthesis). 



CHEMISTRY AND METALLURGY. 23 5 

Give the formula of carbolic acid, Mention an 
antidote. 

Carbolic acid, C 6 H 6 0. 

Antidote, a soluble sulphate, as epsom salt. 

By what force do atoms unite to form compounds ? 
Give an example. 

By the force of chemical affinity. 
Example, H 2 +Cl 2 -|-electricity==2HCl. 

Mention a solvent for gold and platinum, giving 
formula. 

Aqua regia; 3HC1+HN0 3 =2H,0 + NOC1+ 

Cl 2 . 

What is a chemical equation ? 

A chemical equation gives the formulae of sub- 
stances that undergo chemical action and the for- 
mulae of substances produced by chemical action. 

What is the source of tartaric acid ? Give its use 
in medicine. 

Fruit substances, particularly grape juice, in 
which it occurs as a salt called argol. Used in 
medicine as one of the ingredients of Seidlitz Powder, 
and its potassium and sodium salt is used as a laxa- 
tive. 

How is molecular weight obtained ? 

By adding the atomic weights of the elements 
forming a compound or by taking twice the density 
of a compound. 

What is meant by chemical reaction ? 

Chemical reaction represents by formula the re- 



236 CHEMISTR Y AND METALL URGY. 

arrangement of atoms and radicals after they have, 
through chemical action, been separated from their 
former union. 

Name three metals and give the symbols and 
the atomic weight of each. 

Iron, Fe, 56. 

Gold, An, 196.6, 

Aluminum, Al, 27. 

What is ozone ? Name some of its properties ? 

Ozone, 3 , is electrified oxygen and is a blue gas 
acting strongly as a bleaching and disinfecting agent. 
Pure gas is irritating when breathed. 

Name the constituent elements and the properties 
of the atmosphere. 

Oxygen, active substance in supporting life. 

Nitrogen I ^ j-i i- -, 

> 1 o dilute oxygen to proper limit. 

Few others. 

How is aluminum obtained ? Give its symbol and 
its atomic weight. 

Aluminum is obtained by electrolysis upon fused 
bauxite. 

Symbol, Al. 
Atomic weight, 27. 

Give process of refining Gold by chemicals. 

By fusing silver with gold, rolling it thin, and 
subjecting it to the action of nitric acid or sulphuric 
acid. 



CHEMISTR Y AND METALL URG Y. 237 

Name three acids used in medicine. Give form- 
ula for each. 

Acetic Acid, HC 2 H 3 2 . 

Sulphuric Acid, H 2 S0 4 . 

Hydrochloric Acid, HC1. 

Describe five metals and give the fusing point of 
each. 

Tin (fusing point, 442 ° F.) is a soft, silvery white, 
malleable metal, and is present in solder. 

Lead (fusing point, 61 7 F.) is a bluish, soft, 
malleable, ductile metal ; it is slightly tenacious and 
resists the action of sulphuric acid. 

Zinc (fusing point, 779 P.) is a silvery white, 
highly crystalline, brittle metal ; it is ductile 
and malleable at certain temperatures. It is used in 
solder. 

Gold (fusing point, 201 2 F.) is a yellow, soft, 
most malleable and ductile metal ; it is insoluble in 
single acids. 

Copper (fusing point, 2192 F.) is a flesh color, 
or reddish, malleable metal ; it is ductile, tenacious, 
tough and soft. 

Describe the chemical process by which minerals 
are converted into animal food. 

Mineral substances are dissolved in water from 
which they are absorbed by the rootlets of plants; then, 
stored in the tissues or fruits of the plant, they con- 
stitute a food for animals. This, undergoing pro- 
cesses of digestion and absorption in the animal, is 
converted into animal tissue. 

What is the difference between two acids com= 
posed of the same elements, the name of the one ending 



2j8 CHE MIS TR Y AND MET ALL UR G Y. 

in OUS, and that of the other in IC ? Illustrate, giving 
name and formula. 

The one ending in ous contains relatively less 
oxygen than the one ending in ic. 

Sulphurous Acid, H 2 SO s ; Sulphuric Acid, H 2 

so 4 . 

Write the equation showing the reaction of sul= 
phuric acid on common salt. State a general theory to 
this particular reaction. 

If two chemical compounds be brought in contact 
with each other, should one or more elements of one 
of the compounds have an attraction or affinity for 
one or more elements of the other compound, these 
elements will leave their compound, and, uniting, 
form new bodies. 

H 2 S0 4 + NaCl = NaHS0 4 + HC1. 

Distinguish between an element and a compound. 
Give an example of each. 

An element is a substance, the molecules com- 
posing which, contain the same kind of atoms ; for 
example, copper, gold. A compound is a substance, 
the molecules composing it are formed of different 
kinds of atoms, e. g. water, alcohol. 

Define effervescence, hydrate, and hydrite. 

Bffervescence is the escape of a gas through a 
liquid, producing bubbling. A hydrate is a combin- 
ation of a metal with a member of the water type, as 
KHO. An hydrite is an oxide of an elementary sub- 
stance, usually nonmetallic, which will unite chemi- 
cally with water to form an acid. 



CHEMISTR Y AND METALL URG Y 2 39 

riention six nonmetallic and six metallic elements. 
Give the symbol of each 

Non-metallic : Metallic : 



Chlorine, CI. Iron, Fe. 

Iodine, I. Copper, Cn. 

Bromine, Br. Gold, An. 

Fluorine, F. Silver, Ag. 

Sulphur, S. Mercury, Hg. 

Boron, B. Calcium, Ca. 

Give an example of (a) a physical change, (b) a 
chemical change, (c) a mixture, (d) a chemical compound. 

(a) The dissolving of iodine in alcohol. 

(b) Union of silver with nitric acid to form lunar 
caustic. 

(c) Iron filings with sulphur. 

(d) Apply heat to above, they unite chemically 
to form a body having different properties than either 
alone. 

Classify the following acids, bases, or salts ; (a) 
lime, (b) vinegar, (c) cream of tartar, (d) baking soda, 
(e) ammonia. 

Acids : Bases : Salts : 

Vinegar Lime Cream of Tartar 

Ammonia Baking Soda 

How does N 2 rank as a supporter of combustion 
and respiration ? 

It supports combustion but does not support ani- 
mal respiration. 

Define negative element, positive element. Men- 
tion the conditions under which negative and positive ele- 
ments act on each other. Illustrate this action. 



240 CHEMISTR Y AND ME TALL UR G Y. 

A negative element is one which if freed from a 
compound by electrolysis would be found at the posi- 
tive electrode. A negative element is one that com- 
bines with oxygen to form an acidulous compound. 
A positive element is one that combines with oxygen 
to form a basic or neutral oxide. A positive element 
is a metal. A negative element is a metalloid. 

How is matter classifed ? 

Simple and compound. 
Mineral, animal and vegetable. 
Organic, inorganic and organized. 
Atom, molecule and mass. 

What does HO represent ? 

One molecule of peroxide of hydrogen. 

What per cent, of C0 2 exists permanently in the 
atmosphere ? What per cent, of CO is dangerous to life ? 

Four parts of CO a exists permanently in ioooo 
parts by weight of air. More than six parts in 
10 ooo parts, if accompanied by respiratory impurities, 
is dangerous to life. 

Air containing one-twelfth of its volume of C0 2 
produces suffocation. 

In what condition are elements generally found in 
nature ? flention two exceptions. 

In combination with other elements forming 
compounds. Exceptions diamond and oxygen in the 
air. 



CHE MIS TR Y AND ME TALL UR G Y 241 

In making dental alloy, state the order of fusing 
the metals so that volatilization of the base metal may be 
prevented. 

Melt the highest fusing metal first. Protect its 
surface well with borax. Add the other metals in 
the order of the fusing points, the lowest fusing metal 
last. 

For what element is there the most extensive 
affinity ? 

Oxygen. 

Describe the preparation of plaster=of=Paris. Ex= 
plain the setting of plaster=of=Paris. 

By roasting gypsum at temperatures between 
300 and 400° F., when it looses about ^3 of its water, 
and then powdered. In the setting, the water added 
to it unites to plaster-of-Paris to give a substance 
closely resembling gypsum. 

What salt of silver is used in dentistry ? Give 
its formula. 

Nitrate of silver, AgN0 3 . 

Mention four compounds giving the symbol and 
the molecular weight of each. 

C0 2 — Carbon dioxide — 44. 

S0 2 — Sulphur dioxide — 64. 

N 2 — Nitrous oxide — 44. 

H 2 2 — Hydrogen peroxide — 34. 

What metal is the best conductor of heat ? Of 
Electricity ? 



2^2 CHEMISTR Y AND METALL URGY. 

Silver is the best conductor of heat and electri- 
city. 

What is a metal ? 

An element generally solid, at ordinary tempera- 
tures (mercury is an exception) fusible by heat, insol- 
uble in water, with a metallic lustre and properties of 
conducting heat and electricity. 

Name three light metals, giving the symbol and the 
atomic weight of each. 



Metal. 


Symbol. 


Atomic Weight. 


Lithium : 


Li. 


7- 


Potassium : 


K. 


39- 


Sodium : 


Na. 


23- 



Define atom, molecule. 

An atom is an individual particle of an element. 
A molecule is the smallest part of any substance that 
can exist alone and exhibit the properties of that sub- 
stance. It is a cluster of two or more atoms bound 
together by chemical affinity. 

Give the number of elements ? Name three ele= 
ments stating symbol and atomic weight of each. 

There are about 76 elements. 

Element 

Oxygen : 

Hydrogen : 

Nitrogen : 

What is meant by analysis ? 

Analysis is the process of determining the comp- 
position of a body by separating the elements. 



Symbol 


Atomic Weight 


O. 


16. 


H. 


1. 


N. 


14. 



CHEMISTR Y AND METALL URG Y. 243 

What is synthesis ? 

Synthesis is the process of producing bodies by 
combining elements. 

Give the atomic weight and the symbol of gold, 
silver. 

Metal Symbol Atomic Weight 

Gold : Au. 197. 

Silver : Ag. 108. 

State the theory of valence. 

Valence expresses the numerical power for union 
by volume which different elementary substances 
show. 

State how to obtain an atomic weight. 

The atomic weight equals 6.4 divided by the 
specific heat of the element. 

Define electrolysis. Describe an experiment illus= 
trating electrolysis. 

Electrolysis consists of the separation of the con- 
stituents of a compound through the action of an 
electric current. Iodine may be separated from potas- 
sium by passing an electric current through a solution 
of potassium iodide. 

Describe in detail the process of electro=p!ating. 

A trough made of wood contains a solution of 
chloride and cyanide of gold. Two wires from a bat- 
tery pass over the trough. From one, the positive 
wire, is suspended a gold coin. From the other, the 
negative wire, is suspended the object to be plated. 
The current flowing, gold leaves the solution and is 



244 CHEMISTR Y AND METALL URGY. 

deposited upon the object to be plated. The weak- 
ened solution then dissolves from the gold coin suffi- 
cient gold to restore its strength. 

Compare gold, silver, copper and tin as to conduc= 
tivity of heat? 

Silver, copper, gold, tin. 

Give the name and the properties of H 2 S0 4 . De= 
scribe the manufacture of H.,SO,. 

H 2 S0 4 is sulphuric acid. It is highly corrosive, 
strong acid, heavy, oily-like liquid. It is known as 
a mineral acid, combines with water with great eleva- 
tion of temperature. Dissolves many metals. 

Sulphur or a sulphide is burned in air and the 
resulting S0 2 gas together with HN0 3 gas and 
steam pass into a leaden-lined chamber. These 
three vapor substances combine to form H 2 S0 4 , 
which liquefying falls in a rain to the floor of the 
chamber ; from this it is removed and concentrated 
by heat. 

Give the properties of iodine and state its use in 
dentistry. 

Iodine is a solid, purplish-black, shining, scale- 
like substance, non-metallic, but slightly soluble in 
water and freely soluble in alcohol, ether, and chloro- 
form. Its solution in alcohol is known as a tincture 
and is a counter-irritant ; a stronger tincture contains 
ether and is known as the dental tincture. It is used 
to remove green color from teeth. 

What is meant by spectrum analysis ? 

Spectrum analysis is a method for recognizing 



CHEMISTR Y AND ME TALL UR G Y. 245 

the presence of different substances owing to charac- 
teristic optical effects produced when such substances 
are viewed through a prism. 

Define cohesion, adhesion, elasticity. 

Cohesion is that force wdiich binds the mole- 
cules of like character together. It is interior union. 

Adhesion binds molecules of unlike character 
together. It is surface union. 

Elasticity is that property by virtue of which 
substances resume their former size and shape when 
they are relieved from the action of force upon them. 

Distinguish between oxygen and ozone. 

Oxygen is a colorless gas, and there is no diffi- 
culty experienced in inhaling it. 

Ozone has a blue color and is very irritative 
when inhaled. 

Ozone may produce hemoptysis. Ozone is far 
more active in oxidizing substances than oxygen. A 
molecule of oxygen contains two atoms, while a 
molecule of ozone contains three atoms. 

Distinguish between alkali and alkaloid. Give 
examples. 

An alkali is an oxide or hydrate of an alkaline 
metal. It is a miueral substance turning red litmus 
blue. It neutralizes acids to form salts and water, 
forming soaps and fat. 

An alkaloid is an active principle of an organic 
substance, and is alkaline in reaction ; it always con- 
tains nitrogen and, in addition, carbon, hydrogen, and 
often oxygen. 



246 CHEMISTR Y AND MET ALL UR G Y. 

Alkali, e. g. caustic soda, caustic potash. 
Alkaloid, e. g. morphine, nicotine. 

Describe the construction of each of two galvanic 
cells and mention the chemicals used in each. 

Grove cell. — Hard rubber cup filled with dilute 
H 2 S0 4 , containing U shaped strip of zinc. Immersed 
in this cup is a porous cup filled with strong nitric 
acid and sheet of platinum. 

Bunsen cell. — Exactly as above save that carbon 
is in porous cup in place of platinum. 

Describe the preparation of hydrogen. 

Place zinc in sulphuric acid and hydrogen gas 
will be evolved. 

Give the manufacture of chloroform. 

Chloroform is obtained by distilling a mixture 
of bleaching salt of lime and alcohol. 

By what processes are constituents of compounds 
obtained ? Give an example. 

By electrolysis and by heat. Separation of oxy- 
gen and hydrogen from water by electrolysis. 

Separation of oxygen and mercury from mer- 
curic oxide by heat. 

Explain the use of atomic weights. 

Atomic weights are used as combining weights, 
giving us the proportion by weight of one element 
required to unite with a definite weight of a second 
element in forming a compound. 

How can it be determined that the composition of 
water is H 2 0. ? 



CHEMISTRY AND METALLURGY. 2tf 

By passing an electric current through water 
obtaining the two gases hydrogen and oxygen. (Anal- 
ysis). By mixing two volumes of hydrogen and one 
volume of oxygen and passing an electric spark 
through it, the result producing water. (Synthesis). 
Define metallurgy. 

Metallurgy treats of the economical extraction 
of metals from their ores and the application of 
metals to useful purposes. It includes a description 
of the metal. 

Explain the use of symbols and formulae. Give 
and translate five examples of each. 

A symbol is used to represent one atom of an 
elementary substance. 

A formula is a combination of symbols that re- 
present one molecule of a substance. 

Examples of symbols. --Oxygen, O; hydrogen, 
H; sulphur, S; Nitrogen, N; chlorine, CI. 

Examples of formula.— Water, H 2 ; nitric acid, 
HN0 3 ; sulphuric acid, H 2 S0 4 ; hydrochloric acid, 
HC1 ; ozone, 3 . 

Mention three heavy metals. Give symbol and 
atomic weight of each. 

Gold, Au. 196.6; platinum, Pt. 197; mercury, 
Hg. 200. 

flention five constituents of the atmosphere. 

Oxygen, nitrogen, argon, water vapor, carbon 
dioxide. 

Give use of sulphuric acid in dentistry. 



248 CHEMISTR Y AND METALL URG Y 

Used as a local application in root canals, clean- 
ing plates, refining gold, pyorrhoea. 

Where gold and amalgam are used in approximate 
cavities, which metal has the greater effect on the sur= 
rounding dentine ? 

Gold. 

State a process by which the constituents of mat= 
ter are obtained. Illustrate. 

By electrolysis of water we may obtain its con- 
stituents in gaseous form. 

State use of H 2 2 . 

As a disinfectant, bleaching and oxidizing agent. 

Distinguish between a simple molecule and a com= 
pound molecule. 

A simple molecule is composed of atoms of the 
same kind. A compound molecule is composed of atoms 
of different kinds. 

flention two ways in which elements occur in 
nature and give examples of three elements occurring in 
both of these ways. 

In uncombined state. In compounds or union 
with other elements. 

Oxygen mixed with nitrogen equals air. 

Oxygen combined with metals occurs as oxides. 

Nitrogen found elementary in the air. 

Nitrogen found combined in nitrates. 

Carbon found elementary in diamonds. 

Carbon found combined in carbonates. 



CHEMISTR Y AND MET ALL UR G Y 249 

Define anhydrous, alkaline, neutral. 

Anhydrous is a substance deprived of water ; as, 
anhydrous sulphate of copper. 

Alkaline refers to the property a substance has 
which, when in solution, turns red litmus paper blue, 
unites with and neutralizes acids, forming salts; emul- 
sifies fats, makes soap, and possesses a harsh acrid 
taste. 

Neutral refers to that condition in which a sub- 
stance showing neither acid nor alkaline properties 
does not affect litmus in color. 

Define tenacity. 

Tenacity refers to the strength or resistance sub- 
stances show to mechanical force seeking to pull the 
molecules apart. 

riention (a)two disinfectants, (b) two antiseptics. 
Give an example of the use of each. 

S0 2 , sulphur dioxide, and H 2 2 , hydrogen per- 
oxide, are two disinfectants. Sulphur burned in a 
room produces S0 2 , which destroys germs. Hydro- 
gen peroxide in official solutions is added to collec- 
tions of pus when, by direct oxidation, it destroys 
the germs present. Bichloride of mercury and boric 
acid are two antiseptics. The parts bathed by a 
solution of bichloride of mercury in a proportion of 
one part in two thousand parts of water, render the field 
non-fertile for development of germs. Boric acid in 
three per cent, solution applied to the eye renders 
the field non-supportive of germ life. 



2 so CHE MIS TR Y AND ME TALL UR G Y. 

Define chemical affinity. 

Chemical affinity is a peculiar force which acting 
at inappreciable distance binds elements and com- 
pounds together in chemical union forming new 
bodies. 

What proportion of the air is nitrogen ? 

One-fifth. 

Give formulas of three chemical compounds. 

Water, H 2 ; nitric acid, HN0 3 ; potassium 
iodide, KI. 

How is molecular weight obtained ? Give illus= 
trations. 

Molecular weight is obtained by taking the sum 
of the atomic weights. 

Molecular weight of H 2 equals 2 + 16 or 18. 
Molecular weight of H 2 S0 4 equals 2-1-32+64 or 

98. 

flention three acids commonly employed in dent= 
istry and give the specific use of each. 

Sulphuric acid, — local application to root canals. 
Also used for refining gold and cleaning plates. 

Nitric acid, — used for refining gold, dissolving 
metals, and as an oxidizing acid. 

Glacial phosphoric acid, — its solutions are added 
to zinc oxide in making oxyphosphate of zinc cement. 

Describe a method of (a) refining gold sweepings 
and fillings, (b) separating gold from platinum. 



CHEMISTRY AND METALLURGY. 251 

(a) Roast with potassium nitrate in a well 
boraxed crucible and pour out into moulds. 

(b) Dissolve the alloy of gold and platinum in 
aqua regia, dilute well, and add ferrous sulphate sol- 
ution ; collect the precipitate, wash with water, heat 
to fusion, and mould in ingot. 

Give the symbol and the valence of each of the fol= 
lowing; Hydrogen, oxygen, nitrogen, carbon, gold, iron, 
mercury, potassium. 





Symbol 


Valence 


Hydrogen, 


H 


1 


Oxygen, 


O 


2 


Nitrogen, 


N 


5, 3 ° r i 


Carbon, 


C 


2 or 4 


Gold, 


An 


3 or 1 


Iron, 


Fe 


2 and 4 


Mercury, 


Hg 


2 


Potassium, 


K 


1 



State the conditions that generate galvanic cur= 
rents between gold and amalgam fillings and the condi= 
tions under which such currents may be avoided. In case 
of galvanic currents which metal, gold or amalgam, 
most affects the pulp ? 

If gold and amalgam fillings be in contiguous 
teeth and there be an acid salivary secretion, gal- 
vanism may occur. Currents may be avoided by not 
bringing different metals close together and by neu- 
tralizing acid saliva. 

Under the influence of galvanism gold affects 
the pulp most. 

What salt of iron is used as an antidote for ar= 



2 5 2 CHEMISTR Y AND METALL URG Y 

senic poisoning ? State how this salt may be rapidly pre- 
pared. 

Freshly prepared hydrated sesqui oxide of iron. 
This may be obtained by adding a teaspoonfnl of 
ammonia to a cupful of tincture of the chloride of 
iron and quickly washing the precipitate with water. 

Give the common names of Ii 2 0, HNO , H 2 C0 3 , and 
N 2 0. 

H 2 0, water ; HN0 3 , nitric acid ; H 2 CO„ carbonic 
acid ; N 2 0, laughing gas. 

What special properties of metals are most af= 
fected by alloying. 

Malleability and ductility are lessened. Tenacity 
and hardness are increased. Fusibility is lowered. 

Mention five elements, giving the symbol and the 
atomic weight of each. 

Symbol 
Oxygen, O 

Sulphur, S 

Iron, Fe 

Aluminum, Al 

Gold, Au 

Describe the Bunsen burner and give the chemis- 
try of its flame. 

The Bunsen burner consists of a tube for the 
burning of gas, at the bottom of which are apertures 
for the admission of air. The air so dilutes the gas 
that all parts of the gas undergo combustion ; carbon 
dioxide" and water result from the burning. 

Describe the apparatus for generating electric cur- 



Atomic we 


ight 


16 




32 




56 




27 




196.6 





CHEMISTR Y AND MET ALL UR G Y. 2 5 j 

rents from chemical action. State the chemical action in= 
volved in the process. 

A sheet of copper and a sheet of zinc placed in 
dilute sulphuric acid Mall generate an electric current 
because the zinc will be acted upon chemically by the 
acid more than the copper. A solution of sulphate of 
zinc will form in the acid. 

Mention four of the principal elements found in 
the human body. 

Sodium, oxygen, calcium and iron. 

Give some of the characteristics of aluminum. 
State how aluminum is obtained from the ore. 

Aluminum is a white metal and is malleable, 
strong and tenacious ; it does not tarnish in the air 
and has a specific gravity of 2.58. It is obtained 
from bauxite by passing an electric current through 
it when fused. Bauxite is a hydrated silicate of alu- 
minum. 

Describe the manufacture of N 2 0. 

N 2 is obtained by heating ammonium nitrate at 
heat not exceeding 470 F. to 500 F. The vapor 
then passes through potassium hydrate solution, then 
through ferrous sulphate solution and then through 
water. Reaction— NH 4 N0 3 + heat=2H a O+N 2 0. 

Give an antidote for carbolic acid. 

A soluble sulphate, as magnesium sulphate. 
What is understood by H 2 S0 4 ? 

One molecule of sulphuric acid. 



254 CHEMISTR Y AND ME TALL UR G K 

Give an antidote for corrosive sublimate and sugar 
of lead. 

Albumen, as white of egg, is an antidote for cor- 
rosive sublimate. A soluble sulphate, as epsom salts, 
is an antidote for sugar of lead. 

What is fermentation ? 

Fermentation is the decomposition of non-nitro- 
genous organic substances produced through the 
agency of nitrogenous bodies called ferments. 

Give two methods of refining gold. 

The roasting process. — Impure gold is placed in 
a graphite crucible that has been well boraxed, its 
surface is covered with potassium carbonate, heated 
to fusion, when potassium nitrate and more borax are 
added ; after roasting for from one-half hour to an 
hour, base metals are oxidized and resultant refined 
gold is poured into a mould. 

Wet method. — By quartation, add approximately 
three times as much silver as gold, fuse, cool, roll 
out, and digest in nitric acid or sulphuric acid, when 
gold is left undissolved. 

How do you reduce to higher from lower carat ? 

To reduce gold from a lower to a higher carat 
add pure gold or fine alloy. As the alloy in the re- 
quired carat is to the alloy in the given carat, so is 
the weight of the alloyed gold, used, to the weight of 
the reduced alloy, required. The weight of the al- 
loyed gold, used, subtracted from this, gives the 
amount of pure gold to be added. 



CHEMISTR Y AND mAtALL URG K 255 

What is the difference between assay and analy= 



sis ? 



Ail assay is a process for determining the pro- 
portion by weight, of one or several metals in a com- 
pound, as an ore. Ananalys is is used for determining 
the proportion by weight of all substances in a com- 
pound non-metallic as well as metallic. 

Give common name for zinc sulphate, copper sul= 
phate, aluminum oxide. 

Zinc sulphate— White vitriol. 
Copper sulphate— Blue stone. 
Aluminum oxide— Alumina. 

How do you find the carat ? 

As the weight of the alloyed mass is to the 
weight of gold it contains, so is 24 to the standard 
sought. 

( Gold 6, ~\ 
What carat would 1 Silver 2, |- be ? 

( Copper 1, J 

9 : 6 : : 24 : x 

x=6x24-^9=i6, etc. 

Would you use silver in making plates ? Why ? 

No. Because silver is blackened by the sulphur 
gases forming in the mouth from the decomposition 
of food particles. 

State the properties of N 2 which make it of use 
in medicine. 

It is used for producing anesthesia of short dura- 
tion . 



256 CHEMISTR Y AND METALL URG K 

Mention the chemical constituents of saliva. 

Water, 994.10 

Solids : 

Ptyalin, - 1.41 

Fat, ------ 0.07 

Epithelium and Proteids (including 
serum-albumen, globulin, mucin, 

etc.) 2.13 

Salts : 

Potassium Sulpho-Cyanate, 

Sodium Phosphate, 

Calcium Phosphate, 

Magnesium Phosphate, 

Sodium Chloride, 

Potassium Chloride. 



1000 

What is the difference between a mixture and a 
chemical compound ? 

Mixtures are joined together by adhesion and 
cohesion, and can be separated by such mechanical 
means as heat and filtration, and may be mixed in 
any proportion. 

A chemical compound is one joined by chemical 
affinity. 

Give the formula and properties of (a) hydro= 
chloric acid, (b) sulphuric acid, (c) sulphurous acid, (d) 
phosphoric acid. 

Hydrochloric acid (HC1) is a colorless gas, has a 
sharp penetrating odor, and is very irritating when 



CHEMISTRY AND METALLURGY. 257 

inhaled. It is neither combustible nor a supporter of 
combustion, and has great affinity for water. Whilst 
hydrochloric acid is a gas, this name is used also for 
its solution in water. The hydrochloric acid of the 
U. S. P. is an acid containing 31.9 per cent, of HC1, 
and is a colorless, fuming liquid. 

Sulphuric acid (H 2 S0 4 ). Pure acid has a specific 
gravity of 1.848 ; it is a colorless liquid, of oily con- 
sistence and has a great tendency to combine with 
water, absorbing it readily from atmospheric air. Upon 
mixing sulphuric acid and water heat is generated. 
It also has the property of destroying and blackening 
organic matter, and has poisonous caustic properties. 
The sulphuric acid of the U. S. P. should contain not 
less than 92.5 per cent, of H 2 S0 4 . 

Sulphurous acid (H 2 S0 3 ) is a colorless acid liquid, 
which has the odor as well as the disinfecting and 
bleaching properties of the dioxide ; it is completely 
volatilized by heat. The acid is easily oxidized by 
the air. 

Phosphoric acid (H 3 P0 4 ) is a colorless, odorless, 
strongly acid liquid, which, on heating, loses water, 
and finally is volatilized at a low red heat. 

Give two methods of obtaining hydrogen. 

(1) By the action of zinc on sulphuric acid. 

(2) By the electrolytic decomposition of water. 

Give the symbol and the method of preparation 
of iodine. State use of iodine in dentistry. 

Iodin (I) is prepared from any iodid by the 



2 5 8 CHEMISTR Y AND METALL URGY. 

action of a mixture of manganese dioxid and sul- 
phuric acid. 

2KI+MnO,+2H 2 S0 4 =K J S0 4 +MnSO + +2H a O+I a . 

The tincture is a counter-irritant, astringent, 
and antiseptic, in the latter office particularly useful 
in the last stages of putrefactive decomposition. In 
strong tincture, combined with tincture aconite, it is 
applied to the gums in chronic pericementitis as a 
counter-irritant. In diluted tincture it is applied as 
an antiseptic and astringent in cases of congestion of 
the gums and pyorrhea alveolaris. 

Give test for arsenic, antimony and gold. 

Reinsch's test for Arsenic : A thin piece of cop- 
per, having a bright metallic surface, placed in a 
strongly acidified solution of arsenic becomes, upon 
heating the solution, coated with a dark steel-gray 
deposit of arsenic, which can be vaporized by appli- 
cation of heat. 

Test for Antimony : Add hydrogen sulphide to 
an acidified solution of antimony ; an orange-red pre- 
cipitate of antimonous or antimonic sulphide is pro- 
duced. 

Test for Gold : Add hydrogen sulphide to a sol- 
ution of gold ; brown auric sulphide is precipitated, 
which is soluble in yellow ammonium sulphide. 

How many nitrogen acids are there? State the 
name and formula of each. 

Nitric acid, HN0 3 , Nitrous acid, HN0 2 ; Hypo- 
nitrous acid, HNO or possibly H 2 N 2 2 . 



CHEMISTR Y AND METALL URG Y 25Q 

What is meant by potential as applied to electric 
bodies ? 

Potential is the difference in electrical conditions. 
It represents a stored force, and is present before the 
wires are connected. It is to electricity what temper- 
ature is to heat. 

State the salts that enter into the formation of 
human bone. 

Calcium phosphate, sodium chloride, magnesium 
phosphate, calcium fluorid. 



HISTOLOGY. 

What is spongioplasm ? 

Spongioplasm is a part of the protoplasm of a 
cell. It is a very delicate network which supports 
the fluid portion of the protoplasm. 
What is the nucleus of a cell ? 

The nucleus is usually a round or oval body sit- 
uated in the interior of the cell body. It consists, 
like the protoplasm, of two parts ; (i), the chromatin, 
having, as the name implies, a great affinity for 
stains ; it is arranged in the form of a delicate reticu- 
lum. (2), The achromatin, a clear semi-fluid sub- 
stance, staining feebly, if at all, and occupying the 
meshes of the chromatin. Within the nucleus may 
be seen one or more smaller rounded bodies, — the 
nucleoli. The nucleus is in many instances limited 
by a distinct nuclear membrane. 

What is nuclear matrix ? 

The nuclear matrix is the inter-fibrillar substance 
of the nucleus. A clear semi-fluid, homogeneous 
siibstance. 

Is dentine developed inwardly or outwardly ? 

Dentine develops from without toward the 
papilla. 

In what manner does dentine increase ? 

By a gradual deposit by the odontoblasts, of 



HISTOLOGY. 261 

layers of a substance which later becomes calcified. 

What would be the result of exposing dentine to 
the actions of a strong acid for several days ? 

The earthy substance would be removed and a 
substance yielding gelatin would remain. 

Name the salivary glands, where do they empty ? 

The parotid has its duct leading to the oral 
cavity entering opposite the second molar tooth of the 
upper jaw. The sub-m axillary enters the mouth 
on the summit of a small papilla at the side of the 

frenum of the tongue. The sublingual gland has 
its outlet at several points on either side of the fre- 
num of the tongue. 

What is the structure of human enamel ? 

Enamel is an exceedingly hard substance. It is 
composed of elements prismatic in shape, usually six 
sided, placed vertically to the dentine, and are united 
by a cement substance. It exhibits parallel stripes 
representing strata of lime salts deposited, called the 
stripes of Retzius. 

What are lacunae ? 

Lacunae are spaces found in compact bone con- 
taining bone cells and lymph. They are in reality 
lymph spaces formed by the osteoclasts. 

Give the varieties of connective tissue. 

White fibrous. 

Yellow elastic. 

Areolar and modifications : Adipose and adenoid. 

Mucous or embryonic. 



* 



262 HISTOLOGY, 

Cartilage. 

Bone. 

Dentine. 

Give the analysis of cementum. 

Cementum has a composition like that of bone. 
Of organic matter, there is about 33%. The 
remainder consists of inorganic substance in the 
form of the phosphates of lime and magnesium, car- 
bonate of lime, sodium chloride and calcium fluoride. 
What is an organic tissue ? 

An organic tissue is one in which the structural 
elements are chiefly, if not entirely, composed of 
living organized substances. 

From what do the lower teeth derive their vas= 
cular supply ? 

From the dental and incisor branches of the 
internal maxillary artery. It divides into a series of 
branches, one of which enters the apical foramen to 
supply the pulp. 

From what do the upper teeth derive their vascu= 
lar supply ? 

From the alveolar or posterior dental and the 
anterior dental branches of the infra-orbital, which 
are branches of the internal maxillary. 

Define lymphatics. Are lymphatics found in the 
teeth ? 

Lymphatics are vessels with exceedingly delicate 
walls, the function of which is to take up the excess 
of nutrient fluids that have been poured from the ca- 



HISTOLOGY. 263 

pillaries for the nourishment of the tissues, and 
return it to the blood stream. They also carry the 
nutrient fluids from the digestive canal. No distinct 
lymphatics have been demonstrated in the teeth. 

What is hemoglobin ? 

The coloring matter of the red blood cell, which, 
when separated from the blood, crystallizes into the 
form of elongated prisms. It is a proteid substance 
having a great affinity for oxygen. 

State the kinds of nerve fibers. 

Medullated, or white fibers ; non-medullated, 
gray, or Remak's fibers. 

State the function of the salivary glands. 

The salivary glands secrete a fluid containing a 
principle called pt3^alin which converts starch into 
sugar, and also aids in moistening the bolus of food, 
thus aiding digestion. 

Describe the secondary dentine. 

Late in life the pulp cavity becomes more or less 
filled with a dense substance, the structure of which 
is intermediate between dentine and bone. It is a 
secondary dentine, also called osteo-dentine. 

Describe a ganglion. 

Ganglia are bulbous structures situated on the 
posterior nerve roots of the spinal cord, on some of 
the cranial nerves and in the sympathetic system. 
They consist of a collection of nerve cells, each being 
enclosed in a capsule which is continuous with the 
sheath of the fiber communicating with it. The cells 



264 HISTOLOGY 

are enclosed in a reticulum of connective tissue which 
also contains additional nerve fibers not connected 
with the cell. 

From what germ layers is epithelium developed ? 

Epithelium is developed from the ectoderm, en- 
toderm and mesoderm. 

What is histology ? 

The term histology is derived from the Greek 
" histos " a web, or tissue ; and " logos " a treatise. 
It is that part of science which has for its object the 
study of tissues. 

What is protoplasm ? 

Protoplasm is a proteid substance, containing, in 
addition, some inorganic substances, viz. : phos- 
phorus, calcium. Structurally it consists of a retic- 
ulum, the spongioplasm, in the meshes of which is 
contained a clear semi-fluid substance, the hyalo- 
plasm. 

What is a cell ? 

A cell is a structural element. It consist of a 
nucleated mass of protoplasm endowed with the 
properties of life, — growth, metabolism, reproduc- 
tion, motion and irritability. 

What is the peridental membrane ? 

It is that part of the alveolar periosteum which 
is reduplicated upon the root of the tooth for the pur- 
pose of binding the tooth in the socket, producing 
the cementum, and of supporting blood vessels. 



HISTOLOGY. 265 

Give analysis of dentine and enamel. 

Dentine contains about 28% of animal matter 
and 72% of earthy matter. Enamel contains but 
about 4% of animal matter. The earthy matter in 
both consists of the phosphates of calcium and mag- 
nesium, carbonate and fluoride of calcium. 

What is a tooth germ ? 

The structure consisting of embryonal tissues 
from which the tooth is developed. 

How is bone developed ? 

(1) In cartilage, where the substitution of cal- 
cified substance is affected by the osteoblasts. (2) 
In fibrous tissue, by the deposit of calcified substance 
upon the bundles of fibrous tissue. (3) From the 
periosteum, by an ingrowth of periosteal buds. This 
variety also substitutes cartilage, but differs from the 
enchondronal in that it grows from the surface. 
What is epithelium ? 

Epithelium is an elementary tissue found cover- 
ing surfaces and lining cavities. The cellular ele- 
ment exceeds the inter-cellular in amount, the latter 
consisting of but a small quantity of inter-cellular 
cement substance. 

What is cartilage ? 

One of the dense forms of connective tissue, the 

matrix of which contains the principle known ' as 

chrondrin. 

Of what is each of the following composed : (a) 
the hair, (b) the nails, (c) the enamel of the teeth ? 



266 HISTOLOGY. 

The hair is a modification of the epithelium of 
the epidermis ; the nails are a very highly developed 
part of the stratum lucidum of the epidermis. The 
enamel of the teeth is a product of the epithelium of 
the oral cavity. 

Describe the Haversian system. 

An Haversian system occurs in compact bone 
and consists of a system of channels through which 
the nutrient fluids pass. It consists of the following : 
a centrally placed canal, the Haversian canal, which 
is surrounded by concentric layers or plates of bone, 
the lamellae. Between the plates of bone are irreg- 
ular clefts, the lacunae, which communicate with each 
other and with the Haversian canal by means of rad- 
ially placed canals, — the canaliculi. 

What is periosteum ? Of what tissues is it 
formed ? 

A membrane which, as its name indicates, in- 
vests the bone for the purpose of supporting the 
blood-vessels, and, also, to take part in the growth of 
bone. It consists of two layers ; ( i ) an outer, com- 
posed of white fibrous tissue, containing numerous 
blood-vessels. (2) The inner, or osteogenetic layer, 
which is rich in elastic fibers and spindle-shaped 
cells, — osteogenetic cells. 

Describe the formation of the teeth. 

The teeth are composed of three substances, — the 
enamel, the dentine and the cementum. The enamel 
covers the exposed part of the tooth, the crown of the 
tooth. The cementum covers the part of the tooth 



HISTOLOGY. 26 j 

within the alveolus of the jaw. The junction of the 
enamel with the ceinentum is called the neck of the 
tooth. The bulk of the tooth is made up of the den- 
tine, which extends from the root to the crown. 
Each tooth contains a cavity, the pulp cavity, which 
communicates with the exterior through a small 
aperture at the apex of the root, the apical foramen. 
The cavity contains a soft connective tissue, — the 
pulp, rich in vessels and nerves. The fang, or root 
of the tooth has a fibrous investment called the peri- 
dental membrane, or periosteum. 

What is an odontoblast ? 

An odontoblast is a modified and specialized con- 
nective tissue cell, for the production of dentine. 

Where are nerve cells found ? Describe their 
structure and functions. 

Nerve cells exist in the gray matter of the cere- 
brum, cerebellum, spinal cord and the posterior nerve 
root ganglia of the sympathetic nervous system, and 
in the medullary portion of the supra-renal capsules, 
according to some authorities. A nerve cell consists 
of a cell body, — a large nucleated mass of protoplasm 
having prolongations or poles, and usually containing 
a nucleus. Nerve cells are classified according to the 
number of processes, as unipolar, bipolar and multi- 
polar. Each nerve cell is the point at which a nerve 
fiber originates in one of the protoplasmic processes, 
known as the axis cylinder process. The other 
processes when present are branched, therefore, are 
called dendrites. The function of nerve cells is to 
generate nervous impulses. 



268 HISTOLOGY. 

Describe the structure of a salivary gland. 

A salivary gland is a tubuloracemose gland. It 
is invested with a fibrous tissue capsule which sends 
trabeculae into the substance of the gland to divide it 
into lobes ; these in turn are subdivided into lobules. 
Each lobule consists of a collection of secreting units, 
the acini, which are composed of glandular epithelium 
resting upon a basement membrane. The secretion 
leaves the gland through its ducts, named according to 
their position in the gland. The interlobular ducts be- 
tween the lobules, the intralobular ducts within the 
lobules, and the intermediate ducts leading from the 
acini to the intralobular ducts. Acini may be of the 
serous type,the cells of which are granular and stained 
deeply ; or mucous, the cells being clear and staining 
faintly. 

What tooth germ first appears and at what 
period ? 

Of the temporary teeth, the germ for the first 
molar appears in the sixth week of embryonic life. 

Is dentine vascular ? Explain. 

Dentine does not contain blood vessels. It prob- 
ably receives its nourishment indirectly from the ves- 
sels of the pulp as does the true bone by means of 
its canaliculi. 

Where is Nasmyth's membrane found ? 

Covering the crown of newly erupted teeth. 
After activity it soon becomes worn away. 



HISTOLOGY. 2 6g 

What is connective tissue ? 

A tissue of mesodermic origin which is composed 
of a cellular and inter-cellular substance, the latter 
being the predominant. The cells vary in shape, be- 
ing round, spindle-shaped, stellate and fusiform, for 
the most part. The inter-cellular substance consists 
of fibres and a matrix which vary in their character- 
istics in various kinds of connective tissue. 

Where does cementum form the thickest ? 

At the apex of the fang of the tooth. 

Mention the structures contained in a cell. 

A typical cell contains a cell wall or membrane, cell 
contents or protoplasm, nuclear membrane, nucleus, 
nucleolus. Some cells contain merely the protoplasm 
and the nucleus. 

What are the primary germ layers ? 

The ectoderm or epi blast, mesoderm or meso- 
blast, entoderm or hypoblast. 

Describe (a) mucous tissue, (b) white fibrous tis= 
sue, (C) elastic tissue. 

(a) Mucous tissue is a transparent, jelly-like 
tissue. Microscopically it is composed of stellate 
cells arranged in a homogeneous semi-fluid matrix. 

(b) White fibrous tissue consists of delicate 
white fibers. It may be dense, as in tendons, or 
loose, as in areolar tissue. The fibers do not branch. 
On boiling fibrous tissue it yields gelatin. 

(c) Elastic tissue consists of yellow highly re- 
flactile fibers which branch freely and have a great 



270 HISTOLOGY. 

tendency to curl at the free ends. The fibers are 
very elastic, and when boiled yield elastin. 

Describe two kinds of bone development. 

In enchondronal bone hyaline cartilage becomes 
transformed into osseons tissue. First the cartilage 
cells multiply and become arranged in vertical rows, 
particularly at the epiphyses, and the substance be- 
tween the cells becomes the seat of a deposit of lime 
salts. In order that the marrow cavity and the 
Haversian canals or spaces be formed, certain cells 
called osteoclasts absorb some of the osseous- tissue. 
In long bones ossification also takes place from the 
periosteum by periosteal buds growing into the car- 
tilage. 

Infra-membranous bone develops in fibrous tissue. 
The bundles of fibres become calcified by the deposit 
of lime salts upon them by the osteoblasts. This 
usually takes place in a manner radiating from a 
centre of ossification. 

Describe osteoblast, osteoclast. 

As osteoblast, is a bone making counective tissue 
cell. An osteoclast is a cell which absorbs the calci- 
fied substance of bony structures. 

State the difference between compact bone and 
spongy bone. 

Compact bone is densely made up, being com-' 
posed of layers of calcified matrix, called lamellae. 
It contains Haversian canals, with concentric lam- 
ellae between the Haversian systems, — interstitial 
lamellae; lamellae concentric with the periphery of 



HISTOLOGY. 271 

the bone ; and, if a long bone, perimedullary lamellae. 
Spongy bone is loosely constructed, being composed 
of an interlacement of calcified septa forming spaces 
called Haversian spaces. 

What tissue binds together the voluntary muscle 
fibers ? 

Extensions from the connective tissue covering 
of the mnscles, called the endo-mysium. 

What is the sarcolemma ? 

The delicate sheath investing the muscle fiber of 
striated voluntary muscle. 

Define neuro=epithelium and state where it is 
found ? 

Neuro-epithelium is of ectodermic origin, and 
consists of modified epithelial cells situated at the 
terminal oj nerves of special sense for the purpose of 
receiving impulses. 

Describe the axis cylinder, the medullary sub= 
stance, the neurilemma. 

These are parts of a so-called medullated nerve 
fibre. The axis cylinder is the essential part ; it be- 
gins at the origin of the nerve fiber in the cell and 
continues to the termination of the fiber. It occupies 
a central position in the fiber and appears to be made 
up of delicate fibrillar, the primitive fibrillae. It is 
said to have a delicate sheath, the axilemma. The 
medullary substance is the substance which invests 
the axis cylinder of medullated fibers. It is known 
as the white substance of Schwann. It is of a fatty 
nature and is regarded as serving to insulate the axis 



272 HISTOLOGY. 

cylinder. It is not continuous, being interrupted at 
points called the nodes of Ranvier. The neurilemma 
is the primitive sheath forming the covering of the 
nerve fiber. It is a structureless, transparent mem- 
brane beneath which are situated nuclei, surrounded 
by a small amount of protoplasm forming the nerve 
corpuscles. 

From what layer of the embryo is the vascular 
system developed ? 

From the mesoderm. 

Where does calcification of a tooth begin ? 

Calcification of the enamel begins at that part 
nearest the papilla. In the dentine, it begins at the 
periphery of the papilla. 

What tissues are derived from the mesoblast ? 

All forms of connective tissue, muscular tissue, 
endothelium of the blood and lymph vessels, pericar- 
dium, endocardium, pleura, peritoneum, spleen, kid- 
ney and ureter, testicle and ducts, ovary and Fallopian 
tubes, uterus and vagina. 

Describe the cellular elements and the fluid por= 
tion of the blood. 

The cellular elements of the blood are the 
erythrocytes, or red blood cells, and the leucocytes, 
or white blood cells. The fluid portion is the plasma, 
or liquor sanguinis, in which the cells are suspended. 
The red blood cells are of a greenish-yellow cast, but 
when massed together give the red appearance to the 
blood. In distinction to the white blood cells, they 
are not nucleated as the latter are. They occur in 



HISTOLOGY. 273 

the proportion of 500 red to 1 white. White blood 
corpuscles have the power of amoeboid motion. 
There are several varieties of leucocytes named accor- 
ding to the character of the nucleus and affinity for 
stains. The most important are the polynuclear 
leucocytes occurring in about 70% of all the leuco- 
cytes. The fluid part of the blood is a somewhat 
sticky, clammy fluid. It contains the factors of 
fibrin, namely, fibrinogen and fibrin ferment, which 
are the agencies active in the clotting of blood. 

Differentiate veins and arteries. 

Veins have, on the whole, much thinner walls 
than arteries in proportion to the calibre of the ves- 
sels. The endothelial cells of veins are broader and 
shorter than in arteries. Veins contain less muscle 
but more connective tissue than arteries. Most veins 
have valves. 

Describe the dental ridge. 

It consists of a linear thickening of the primi- 
tive oral epithelium from which the enamel germ is 
later formed. 

What layers of the embryo contribute to the de= 
velopment of the teeth ? 

The ectoderm and the mesoderm. 

Which of the permanent teeth first calcify? 

The first molars (sixth month) in the upper jaw. 
A little later in the lower jaw. 

What is the origin of the cementum? 



2J4 HISTOLOGY. 

Cementum has its derivation in the alveolar 
periosteum. 

What is a phagocyte ? 

It is a cell possessing the power of amoeboid 
movement, by means of which it takes in and incor- 
porates particles with its own substance. It is 
usually a leucocyte. 

What is a vein ? 

A channel which conveys the blood from the 
capillaries in the tissues to the heart. 

Mention the two groups or systems into which 
the veins are divided. 

The systemic which conveys the blood from the 
periphery of the body, and the pulmonary veins 
which convey the blood from the lungs to the heart. 

What are leucocytes ? 

The colorless corpuscles of the blood, usually 
known as white corpuscles. 

What is adipose tissue ? 

A form of loose or areolar connective tissue in 
which the protoplasm of some of the cells has been 
replaced by fat. 

What are arteries ? 

The vessels which convey the blood from the 
heart to all parts of the body. 

How many kinds of bone tissue are there ? 

Bone is usually divided into two varieties ; ( i ) 
compact, or dense, and (2) cancellated, or spongy. 






HISTO.LOGY. 275 

What is tissue ? 

Tissue is an arrangement of structural elements 
and consists of a cellular and an inter-cellular sub- 
stance. When the structural elements are of the 
same type, it is known as a simple or elementary 
tissue ; when of more than one type, it is a complex 
tissue. 

What is the blastoderm ? 

The blastoderm is a sac-like arrangement of em- 
bryonal cells formed by the cleavage of the ovum. 
It consists of three layers : ectoderm, mesoderm and 
entoderm ; from these all of the tissues of the animal 
body are developed. 

How do cells receive their nourishment? 

Cells are nourished by means of the nutrient 
blood plasma which escapes from the walls of the 
ultimate capillaries in the tissue. The cells are lit- 
erally bathed in the blood plasma. 

Describe metabolism. 

Metabolism is the process by means of which, 
as a result of a series of chemical changes, nutrient 
substances when taken up by the cells, become an in- 
tegral part of the cell substance. 

What is embolism ? 

The obstruction of a blood-vessel by a particle 
of coagulum which has been carried in the blood 
stream from one of the larger vessels until it reaches 
a vessel, the calibre of which is too small to allow it 
to pass. 



2j6 HISTOLOGY. 

What is embryology ? 

That part of science which treats of the develop- 
ment of the embryo is known as embryology. 

What are phleboliths ? 

Literally, " vein-stones ". The term is applied 
to concretions formed in veins. They usually consist 
of dense fibrous bodies, the result of calcification fol- 
lowing a venous thrombus. 

Describe the development of blood vessels and 
lymphatics. 

Having a mesodermic origin, the blood and 
lymph vessels first appear as " cords " of cells which 
later become hollow to form tubes. The innermost 
cells become distinctly flattened to form the endothe- 
lial linings. The first blood vessels have their be- 
ginning outside the body of the embryo, in the 
yolk-sac. 

Describe the muscular tissue. 

Muscular tissue is of mesodermic origin and 
consists principally of elongated cells (fibrous cells) 
which have the inherent power of contracting. The 
muscle fibers contain nuclei and, sometimes, that 
which corresponds to a cell wall, the sarcolemma. 
Voluntary and cardiac muscles are striated, due to 
the arrangement of alternate light and dark discs. 
Non-striated muscle is involuntary. Microscopically, 
they may be differentiated as follows : 



HISTOLOGY, 27~ 

5triated. Non=Striated. Cardiac. 

Fibers striated trans- No striations. Striated longitudinally ar.l 

versely. transversely. 



Has sarcolemma. Hyaline sheath. No sarcolemma. 

Nucleus beneath sar- Nucleus in cen- Nucleus oval and in cente: . 

colemma. i e r. T *--u i 

T-v, A t , , C1 ribers short. 

Fibers do not branch 

except in the tongue.' Fibers branch freely. 

To what class of tissues do the teeth belong ? 

With the exception of the enamel, which is v 
product of epithelium, the teeth belong to the con- 
nective tissue group. 

From what is the six year molar derived ? 

The enamel germ of the first permanent molar 
appears at the extremity of the dental ridge after the 
manner of a temporary tooth ; it appears about a 
week before the budding of the germs of the tem- 
porary teeth. 

Give the principal tissues of the animal body. 

Blood and lymph, epithelium, connective, mus- 
cular and nervous. The blood and lymph are often 
classified with the connective tissue. 

What is exostosis? 

It is a circumscribed overgrowth of the cemen- 
tum, extending beyond the line of the fang of the 
tooth and giving an irregular outline to its external 
surface. 

State the functions of epithelium. 

Protective, secretory, absorptive, to permit ex- 
change of gases, to produce motion (ciliary), for the 
reduction of friction (endothelium), and for the recep- 
tion of nervous impulses. 



278 HISTOLOGY. 

What are the soft fibers of Tomes ? 

Prolongations of the odontoblasts into the den- 
tinal tubules are known as fibers of Tomes. 

State the size, shape and structure of a human 
red blood cell. 

The red blood corpuscles are disc shaped, bi- 
concave, and are 1-3200 of an inch in diameter. They 
are not nucleated ; and, though they probably have 
a delicate cell wall, none can be demonstrated. The 
cell contents contains a substance, hemoglobin, 
which gives the color to the cell. 

Describe the structure of arteries. 

The medium sized arteries are composed of three 
coats or tunics. The tunica intima (inner), consisting 
of an endothelial lining, resting upon a sub-en dothe- 
lial layer of loose connective tissue, which is separ- 
ated from the middle coat by a layer of elastic tissue, 
lamina elastica interna. The tunica media (middle) 
is a muscular tunic and consists of a layer of invol- 
untary (non-striated) muscle fibers circularly ar- 
ranged. The tunica adventiha (outer) consists of an 
admixture of white fibrous and yellow elastic connec- 
tive tissues. This tunic contains small vessels which 
nourish the artery, called vasa vasorum. 

To what tissue does dentine belong? 

To the connective tissue of the dense variety. 

What is bioplasm ? 

The living substance of the cell. The term is 
often used synonomously with protoplasm. 



HISTOLOGY. 279 

flention the varieties of epithelium. 

Squamous, columnar, ciliated, glandular, transi- 
tional, pigmented, and neuro-epitheliuin. The first 
three may occur in a single layer when it is named 
" simple " ; or, in several layers when it is called 
Stratified". 

Describe the more minute structures which evolve 
the sense of taste. 

On the dorsum and sides of the tongue, partic- 
ularly the former, are elevations of the mucous mem- 
brane in the form of papillae. 

A few of the papillae (8-12), situated on the 
posterior part of the dorsum of the tongue, are sur- 
rounded by a furrow, hence called the circumvallate 
papillae. They are arranged in the form of the 
letter "V", the apex being directed posteriorly. 
These papillae usually bear secondary papillae. 
Embedded in the stratified squamous epithelium on 
the surface of the papillae are oval bodies composed 
of modified epithelial cells arranged "like the staves 
of a barrel." These are the taste buds which are 
communicant with the terminals of the gustatory 
nerve. 

The fungiform papillae, more numerous than 
the circumvallate, receive filaments of the nerves of 
taste; but there are fewer of the "special endings" 
than in the circumvallate. Secondary papillae do 
also occur on the fungiform papillae. 

The largest number of the papillae is of the 



280 HISTOLOGY. 

conical or filiform variety, consisting of a conical 
elevation of connective tissue covered with epithelium. 
They carry the terminals of the nerve fibres to the 
periphery. 

Describe the cell structure of articular cartilage. 

The articular surfaces are covered with hyaline 
cartilage, the distinguishing feature of which is the 
translucency of its matrix. The matrix, which pre- 
sents a homogeneous appearance, contains many 
cartilage cells which occupy and completely fill 
spaces called lacunae. Somtimes, two or or more cells 
occur in a single lacuna. The cells are distinctly 
nucleated ; the youngest are spindle-shaped and occu- 
py a position next to the perichondrium, while the 
oldest cells are deeper and are irregularly rounded, 
having a tendency to become angulated. 

How does a mucous membrane differ from a 
serous membrane ? 

Mucous membranes line all cavities communica- 
ting directly or indirectly with the atmosphere. 
They consist of an epithelial covering, the variety of 
which varies with the location, resting upon a con- 
nective tissue base, — the tunica propria. Extensions 
of the epithelium into the connective tissue beneath, 
arranged in the form of tubes or sacs (usually the 
latter) which secrete mucous for the purpose of 
moistening the surface of the membrane, form the 
mucous glands. 

• Serous membranes are found lining closed sacs. 
They consist of a single layer of endothelial cells 



HISTOLOGY, 281 

resting upon a connective tissue membrane. Minute 
openings, stomata, existing between some of the cells, 
communicate with lymph capillaries. The fluid 
found on the surface of serous membranes comes 
from the lymph channels. Serous sacs may be 
regarded as large lymph spaces. 

Describe the pericemental membrane. Give its 
origin and function. 

The pericemental membrane is the fibrous tissue 
investment which covers the root of the tooth. The 
fibres composing it run, for the most part, trans- 
versely. Elastic fibres are notably absent. It has 
its origin in the outer layer of the dental sac. This 
membrane serves to hold the tooth in the alveolus, 
and, to furnish the nutrition to the cementum through 
the blood vessels it carries. Acting as a cushion, it 
seems to diminish shock during mastication. 

Differentiate between osteoclasts and cemento= 
blasts 

Osteoclasts are connective tissue cells found in 
bone forming tissue. It is by their agenc} 7 , the 
absorption of calcified matrix, that the Haversian 
canals and spaces are formed. 

Cementoblasts are also connective tissue cells, 
but their function is that of depositing lime salts in 
the matrix of the cementum. 

Describe the process of dental calcification. 

At about the end of the fourth month, the enamel 
of the temporary teeth is formed. From the extrem- 
ity of the enamel cells, next to the papillae, develops 



282 HISTOLOGY. 

a tuft-like projection, which becomes calcified, forming 
an enamel prism. The process of calcification pro- 
ceeds therefore from within outward. 

At about the same period, the deposit of dentine 
on the sides and apex of the dental papillae begins, 
and therefore proceeds from without inward. Calcifi- 
cation of the dentine is not complete, for the areas 
known as interglobular spaces are not calcified, nor 
are the processes of the odontoblasts, — the dentinal 
fibres. 

Describe the structure, blood supply and nerves of 
the pulp. 

The pulp consists of embr3 T onic connective tissue 
which is composed of stellate cells arranged in a semi- 
fluid, transparent matrix. 

Next to the wall of the pulp canal are columnar 
shaped cells, the odontoblasts, processes of which 
enter the dentine as the dentinal fibrils, 

The pulp is well supplied with blood-vessels and 
nerves which enter at the apical foramen. After 
entering the pulp canal they break up to form plex- 
uses which terminate in the la}'er of odontoblasts. 

The function of the pulp is that of furnishing 
nutrition to the dentine and enamel. Due to the 
rich nerve suppl}^, the pulp is very sensitive. 
From what is the mesoblast derived ? 

The mesoblast has its origin partly in the epi- 
blast and partly in the hypoblast, though chiefly the 
latter. 

What two tissues are formed by the dental pa- 
pilla ? 






HISTOLOGY. 283 

The dentine which is deposited at the periphery 
of the papilla ; and the pulp, which is that portion of 
the papilla remaining after the dentine has been 
formed. 

Describe separately the calcified products of the 
connective tissue. 

Bone may be considered to be of two kinds : 
compact, or dense, and cancellated, or spongy. 

Compact bone consists of a dense matrix con- 
taining lime salts, which matrix contains numerous 
channels for the passage of nutrient vessels and 
fluids, also clefts or spaces, containing bone cells. 
The largest channels (1-500 inch in diameter), called 
"Haversian Canals", run parallel with the long axis 
of the bone and form anastomoses with one another. 
The canals are surrounded with concentric layers of 
osseous matrix : Haversian lamellae, between which 
are small spaces, the lacunae, which in recent bone 
contain bone cells. Radiating from the Haversian 
canals to the lacunae, are minute channels which con- 
vey lymph. They are the canaliculi. The above 
named structures form what is termed an u Haversian 
System." Between the systems, which are circular, 
interstitial lamellae occur, thus filling the space that 
otherwise would exist. 

Lamellae also occur concentrically with the per- 
iphery of the shaft of the bone, the circumjerential 
lamellae, and with the medullary canal, the perime- 
duttary lamellae. 

Spongy bone does not contain Haversian Sys- 
tems, and, therefore, no Haversian Canals. There 



284 HISTOLOGY. 

are, however, as the name implies, numerous spaces 
in the matrix ; they are known as " Haversian spaces. " 

Dentine consists of a calcified matrix in which, 
extending through the entire thickness of the matrix, 
are seen the dentinal tubules which terminate in 
irregular clefts at the junction of the dentine with 
the enamel and cementum. These clefts are known 
as the interglobular spaces. The part of the matrix 
immediately surrounding the tubules forms the den- 
tinal sheaths. The tubules contain processes of cells 
at the periphery of the dentine, — the dentinal fibres. 

Cementum resembles very closely the structure 
of bone. Near the apex of the root, where the 
cementum is thickest, Haversian canals may some- 
times exist, though usually the}' are not present. 

What tissue is the origin of the enamel ? What 
are ameloblasts ? 

Enamel originates in the oral epithelium. 

Ameloblasts are the enamel producing cells. 
They are distinctly columnar in shape and occup} T a 
position in the enamel organ nearest the dentine. 

What cells form Dentine ? 

The odontoblasts. 

Describe the development of the dental papilla ? 

The dental papilla is of connective tissue origin. 
Its position is first evidenced by a proliferation and 
condensation of the mesodermic elements. This col- 
lection of cells soon assumes the shape of a cone, its 
apex pointing towards, and later invaginated by the 



HISTOLOGY. 28 5 

enamel organ. The apex and sides of the conical 
mass become surrounded by columnar cells, -the odon- 
toblasts, which are the producing agents of the 
dentine. 

By what cells, and under what condition does re= 
sorption occur ? 

Cells which are endowed with the function of 
breaking down osseous tissue, namely the osteoclasts, 
are active in the process of resorption. Resorption 
takes place previous to the eruption of the perma- 
nent teeth and is stimulated by the increased blood 
supply stimulated by the pressure of the unerupted 
permanent teeth. 

Describe rieckel's cartilage. 

Meckel's cartilage is a rod of cartilage which 
appears in the mandibular arch, and partly enters into 
the formation of the inferior maxilla, namely, the ex- 
tremity at the symphysis and the proximal extremity, 
which persists with a covering of fibrous tissue to 
form the internal lateral ligament of the jaw. The 
greater part of Meckel's cartilage disappears at about 
the sixth month of foetal life. 

Name the specialized cell for each particular struc= 
ture of the teeth. 

The specialized cell of the enamel is the amelo- 
blast. That for the dentine is the odontoblast. For 
the cementum, the cementoblast. 

What are interglobular spaces ? 

At the junction of the dentine with the enamel 
and cementum are areas which are imperfectly calci- 



286 HISTOLOGY. 

fled ; they are soinewhat globular in shape, hence, 
called interglobular spaces. 

Describe the dental follicle. 

The dental follicle is the result of the condensa- 
tion of the mesodermic cells surrounding the papilla, 
which later extends upward so as to surround the en- 
tire rudimentary tooth. 

Why should there be a difference between the 
structure of dentine and cementum ? 

Dentine is a product of embryonic connective 
tissue through the specialized cell, the odontoblast ; 
while the cementum is produced by the connective 
tissue cells of the alveolar periosteum, the cemento- 
blasts ; therefore, the structure of the cementum re- 
sembles that of bone. 

Describe the enamel organ and the cells that form 
enamel. 

The enamel organ has its origin in a down- 
growth of the oral ectodermic tissue. When full} 7 
developed it consists of a sac, the lower margin of 
which is indented b}^ reason of its contact with the 
underlying papilla ; structurally, it consists of three 
layers of cells. An upper, continuous with the super- 
ficial cells of the ectoderm, a middle layer of stellate 
cells, and an inferior layer of distinctly columnar 
shaped cells. The last named cells are the cells 
which produce enamel. The enamel cells, when ac- 
tive in the production of enamel, exhibit, at their 
lower ext remit}' (toward the papilla), a tuft of short 



HISTOLOGY. 287 

processes. It is along these processes that the de- 
posit of the enamel takes place. 

What is the primitive dental groove ? What 
organ of the teeth is developed from it ? 

A longitudinal furrow, seen on the surface of the 
ectodermic tissue, which marks the point of attach- 
ment of the dental ridge, l}^ing immediately be- 
neath. 

Describe the dental fibrillae; with what are they 
connected, and where do they terminate ? 

The dental fibrillae occupy the dental tubules 
and extend throughout their length. The fibrils are 
protoplasmic extensions of the odontoblasts termin- 
ating at the periphery of the dentine. 

Describe the stratum granulosum. 

At the periphery of the dentine, the substance 
is not completely calcified. As a result there are 
small irregular clefts, the interglobular spaces. This 
layer of the dentine is known as the granular layer. 
What is Neuman's Sheath ? 

The part of the dentinal matrix immediately 
surrounding the dentinal tubules constitute the so- 
called dentinal sheaths, or sheaths of Neuman. 
Describe the process of absorption. 

Absorption depends upon a force known as en- 
dosmosis, which is the change that occurs between 
fluids capable of mixing with each other through an 
animal membrane ; by this process the nutrient 
fluids get from the alimentary canal to the lymph 
vessels. 



288 HISTOLOGY. 

What is calcification ? 

Calcification is the process by means of which 
tissue may become infiltrated with lime salts. It is 
a product of the cellular element of the tissue that is 
deposited in the intercellular substance of which it 
becomes a part. Calcification usually is effected in 
layers, and, in the instance of bone and cementum, 
the well defined lamellae are formed. 

flention the methods of distribution of cells in 
the various tissues. 

On surfaces, (epithelium and endothelium). 
Suspended in fluid, (blood and lymph). 
Interstitially, in a matrix (connective tissues). 

What is perichondrium ? 

A fibrous investment covering cartilage. It con- 
sists of an outer fibrous, the vascular layer ; an inner 
chondrogenetic layer, composed of spindle-shaped, 
cartilage-forming cells, 

Name the varieties of cartilage. 

White fibro-cartilage, yellow elastic cartilage, 
hyaline cartilage. 

Which variety of cartilage does not have a 
perichondrum ? 

White fibro-cartilage. 

How may all tissues be classified ? 

According to (i) their ancestry, (2) function, (3) 
morphological character. 

Explain the difference between epithelium and 
endothelium. 



HISTOLOGY. 



289 



Epithelium and endothelium occur on surfaces, 
but the location, the function and the arrangement 
varies. 

Epithelium. Endothelium. 



Ancestry 



Function 



M cC'tr l fs^-oui 



Ectoderm 
Entoderm 
Mesoderm (rarely) 

C Protective 

Secretory 
J Absorptive 
j Permit exchange of gases 

Motion 
L Nervous 

f Simple and 
Stratified. 



Mesoderm 



Reduction of friction 



Always in a single 
layer 



.' Columnar and 

(^ Polyhedral shaped cells 



Always squamous. 
What is meant by the ancestry of a tissue ? 
Its origin in the blastoderm. 

What is the function of connective tissue ? 

Connective tissue enters into the formation of 
the structure to make a supporting framework ; espe- 
cially where great strength is required. Blood ves- 
sels, nerves and lymphatics are always carried in 
connective tissue. 

What is the structure of capillaries ? 

Capillaries are the ultimate radicles of the vas- 
cular (arterial) system, and consist of a continuation 
of the lining of those vessels ; being made of a single 
layer of endothelial cells, united by a small amount 
of intercellular cement substance. 



ANATOMY. 

flention the branches of the facial artery on the 



face. 



Muscular, inferior labial, , inferior coronary, 
superior coronary, lateral nasal and angular. 

Describe the cavernous sinus. 

It is lodged in the cavernous groove, which is 
situated lateral to the sella turcica of the sphenoid 
bone. It extends from the sphenoidal fissure to the 
apex of the petrous portion of the temporal bone. 
Anteriorily it receives the ophthalmic vein, and behind 
it opens into the petrosal sinus through which the 
cavernous sinus communicates with the lateral sinus. 

Describe the Pons Varolii. 

It is the bridge of union of the various segments 
of the encephalon, connecting the cerebrum above, 
the medulla oblongata below, and the cerebellum 
behind. It is situated above the medulla oblongata, 
below the crura cerebri, and between the hemispheres 
of the cerebellum. It is about an inch in length and 
also in thickness, and about an inch and a half in 
width. 

Describe the superior maxillary nerve (second di= 
vision of the fifth nerve). 

It is a sensory nerve given off from the gasser- 






ANATOMY, 2gi 

ian ganglion. It leaves the cranial cavity through, 
the foramen rotundum, passes through the spheno- 
maxillary fossa, then through the spheno-m axillary 
fissure, enters the infra-orbital canal, and makes its 
exit on the face through the infra-orbital foramen. 
The branches of the nerve may be divided in four 
parts : — 

In the cranium, the meningeal ; 

{orbital, or temporo-malar, 
spheuo palatine, 
posterior superior dental. 

Infraorbital canal i mi f dd ! e su P eri ° r dental, 
( anterior superior dental. 

tpalpabral, 
nasal, 
labial. 

Where is the foramen caecum? What does the 
foramen transmit ? 

It is situated at the junction of the crista galli of 
the ethmoid, and frontal crest of frontal bones. It is, 
as a rule, a blind foramen, but when open, transmits 
a vein from the nose to empty into the superior longi- 
tudinal sinus. 

flention the muscles attached to the temporal 
bone. 

Fifteen, viz.: — temporal, masseter, occipito-fron- 
talis, sterno-mastoid, splenius capitis, trachelo-mastoid, 
digastricus, retrahens aurem, stylo-pharyngeus, stylo- 
hyoideus, stylo-glossus, levator-palati, tensor tympani, 
tensor palati, and stapedius. 

Describe the thyroid gland. 

The thyroid gland is a ductless gland, i. e. one 
that does not possess an excretory duct. It is situated 
at the anterior aspect of the neck in front of the 



292 ANATOMY. 

trachea, and consists of two lateral lobes connected 
across trie middle line by a narrow transverse portion, 
the isthmus. It weighs about one ounce. The lobes 
are conical in shape, the apex of each being directed 
upward and outward and the base downward. 

Give the origin, insertion, nerve supply, and 
action of the pterygoid muscles. 

The external pterygoid muscle arises by two 
heads. The upper head arises from the inferior sur- 
face of the great wing of the sphenoid and the ptery- 
goid ridge, the lower from the outer surface of the 
external pterygoid plate. Its fibers pass horizontally 
backward and outward to be inserted in the depression 
in front of the neck of the condyle of the lower jaw, 
and into the articular fibro cartilage. 

Internal pterygoid muscle arises from the ptery- 
goid fossa and is inserted on the inner side of the 
ramus and angle of the lower jaw. 

The inferior maxillary nerve supplies these mus- 
cles. The external assists in drawing the lower jaw 
forward upon the upper. The internal raises the 
lower jaw against the upper w T ith great force. 

Mention the arteries from which the superior max= 
illary bone derives its blood supply. 

Alveolar, anterior and middle dental, spheno- 
palatine and posterior palatine. 

Describe the salivary glands. Where do these 
glands empty ? 

Three pairs in number ; two parotid, two sub- 
maxillary, two sub-lingual. They are compound 



ANATOMY. 



293 



racemose glands, made up of a number of cells, con- 
nected by a number of tubuli, which empty into a 
central tube leading to their respective ducts (com- 
parable, in shape, to a bunch of grapes). The parotid 
gland is situated in front of the ear and rests upon 
the tympanic plate of the glenoid fossa of the tem- 
poral bone, internally, and extends as far down as 
the angle of the jaw ; anteriorly, overlaps a portion 
of the masseter muscle. The external carotid artery 
passes into the gland and gives off the posterior auri- 
cular, temporal and internal maxillary branches. It 
is also traversed by the facial nerve which emerges at 
its anterior border. Its duct (Steno's) is about two inch- 
es long and empties into the vestibule of the mouth on 
the inside of the cheek, opposite the second upper mol- 
ar tooth. This gland weighs from one-half to one ounce. 

The sub-maxillary gland is situated in the sub- 
maxillary fossa on the posterior part of the body of 
the inferior maxillary bone. It lies on the mylo- 
hyoid and hyo-glossus muscles, and is in relation, 
externally, with the skin and platysma. The facial 
artery lies in a groove embedded in its posterior and 
upper border. Its duct (Wharton's), which is about 
two inches in length, empties into the floor of the 
mouth, on the summit of a small papilla situated on 
the side of the frenum linguae. This gland weighs 
about two drachms. 

The sub-lingual gland is the smallest of the 
salivary glands and is situated in the sub-lingual 
fossa on the internal surface of the body of the in- 
ferior maxillary bone, close to the symphysis. It is 



294 ANATOMY. 

in relation above with the muscle of the floor of the 
mouth (mylo-hyoid). The large duct is known as 
the duct of Bartholin, and empties into the mouth in 
common with Wharton's duct. The smaller ducts, ducts 
of Rivini, 15-20 in number, open into the floor of the 
mouth. 

Mention the bones and ligaments of the temporo= 
maxillary articulation. 

The condyle of the inferior maxillary articulates 
with the glenoid fossa of the temporal. The liga- 
ments are four in number, viz : capsular, internal 
and external lateral, stylo-maxillary. 
Describe the hyoid bone. 

This bone is situated in the supra-thyroid region 
of the neck, at the root of the tongue, serving for the 
attachment of the muscles of that body. It is shaped 
like a horse-shoe, and presents five parts for examina- 
tion viz. — body, two greater, and two lesser cornua It 
is suspended by the stylo-hyoid ligament, which is at- 
tached above to the tip of the styloid process of the 
temporal bone. 

Mention the muscles of the pharynx. 

Inferior, middle and superior constrictors, stylo- 
pharyngeus, palato-pharyngeus and salpingo-pharyn- 
geus muscles. 

Describe and give the articulations of the sphe= 
noid. 

The sphenoid is an irregularly shaped bone, 
situated at the base of the skull. It consists of a 
body, one pair of greater wings, one pair of lesser 



ANATOMY. 295 

wings, and two pterygoid processes. 

The body presents on its upper surface from be- 
hind forward, (a) the dorsum ephippii, surmount. l! 
by the posterior clinoid processes. 

(b) The cella turcica or pituitary fossa for the 
lodgment of the pituitary body ; the fossa limite 1 
anteriorly by the middle clinoid processes. 

(c) An olivary eminence. 

(d) The optic groove for the optic commissur . 

(e) The ethmoidal spine for articulation with 
the ethmoid. Laterally, may be seen the cavernous 
grooves, for the cavernous sinuses. Anteriorly, the 
body presents the sphenoidal crest for articulation 
with the perpendicular plate of the ethmoid ; the 
openings of the sphenoidal sinuses, and the sphenoidal 
turbinated bones. Inferiorly, on the body, is seen 
the rostrum, or beak, which articulates with the vomer. 
Posteriorly, the body is rough, articulating with the 
basilar portion of the occipital bone. 

The lesser wings project from the fore-part of 
the lateral aspect of the body. The anterior border 
of each is serrated to articulate with the frontal. At 
the junction of each wing with the body, is seen the 
optic foramen transmitting the optic nerve and oph- 
thalmic artery. The upper surface is smooth for the 
support of the cerebrum. The inferior surface forms 
the upper boundary of the sphenoidal fissure. 

The greater wing in each instance projects from 
the body of the bone, attached by means of the lin- 
gula. The upper surface is concaved, receiving the 



2 9 6 ANATOMY, 

temporo-sphenoidal lobe of the cerebrum. From 
before backward are seen, the foramen rotundum for 
the second division of the fifth nerve, the foramen 
ovale for the third division of the fifth nerve, the for- 
amen spinosum for the middle meningeal branch of 
the internal maxillary artery. The anterior border 
of the greater wing, together with the body and 
lesser wing, form the anterior lacerated foramen or 
sphenoidal fissure. 

The pterygoid processes extend downward and 
backward. Each process possesses an external pter- 
ygoid plate. At the junction of the internal ptery- 
goid plate with the body and greater wing, a horizon- 
tal canal, called the Vidian, extends from behind 
forward. A subdivided recess is seen between the 
two pterygoid plates, the upper and smaller division 
called the scaphoid fossa, the lower and larger being 
called the pterygoid fossa. Projecting downward 
from the internal plate is the hamular process. The 
sphenoid articulates with the other seven bones of the 
cranium ; also, with the malar, vomer and palate 
bones. 

Describe the ethmoid bone. 

The ethmoid bone is a light spongy bone con- 
sisting of a body and two lateral masses. The body 
presents a horizontal plate, perforated for the trans- 
mission of the olfactory nerve filaments, hence called 
cribriform. Projecting upward from the anterior 
median portion of the horizontal plate is the crista 
galli, serving for the attachment of the falx cerebri. 



/ 



ANATOMY. 297 

The body of the bone also has in relation with it the 
perpendicular plate, which forms part of the nasal 
septum. The lateral mass, or labyrinth, of each side, 
consists of two curling pieces of bone denominated 
respectively the superior and inferior turbinals, lim- 
ited externally by a smooth plate of bone called the os 
planum, which assists in the formation of the inner 
wall of the orbit. Descending from the lateral mass 
is the unciform process articulating with the inferior 
turbinated bones, and assisting in forming part of the 
inner wall of the antrum of Highmore. 

Give origin insertion and action of the buccinator 
muscle. 

Origin, — From the alveolar processes of the super- 
ior and inferior maxillary bones, and behind, from the 
pterygo-maxillary ligament. It is a bipeniform mus- 
cle, its superior fibres blending with the fibres of the 
orbicularis oris in the lower lip, its inferior fibres 
with the fibres of the orbicularis oris muscle of the 
upper lip. Its action is to assist in keeping the food 
between the teeth in mastication ; and is used in such 
acts as whistling, blowing a trumpet or horn. 

What nerve supplies the muscles of expression ? 

The facial or seventh nerve. 

What nerve supplies the muscles of mastication ? 

Branches of the inferior maxillary division of 
the fifth cranial nerve. 

Mention the muscles attached to the occipital 
bone? 



2 9 8 ANATOMY. 

Occipito-frontalis, trapezius, sterno-cleido-mas- 
toid, complexus, splenius capitis, obliquus capitis su- 
perior, rectus capitis posticus major aud minor, 
rectus capitis lateralis, rectus capitis anticus major 
and minor, and superior constrictor of the pharynx. 

Give the articulations of the great wing of the 
sphenoid. 

Superiorly, with the frontal, tip of the parietal, 
the outer and posterior border with the squamous 
and petrous portions of the temporal, and the outer 
border of the orbital surface with the malar. 

What blood vessels supply the antrum and teeth 
of the superior maxillary ? 

The molar teeth are supplied by alveolar 
branches of the internal maxillary artery. The an- 
terior teeth are supplied by the anterior and middle 
dental branches of the infraorbital, (a branch of the 
internal maxillary) artery ; the antrum is supplied 
by a branch of the same artery. 

Give the origin and distribution of the facial 
artery. 

Origin. — Branch of the external carotid, arising 
just above the lingual ; gives off branches in the neck 
to supply the palate, tonsils, sub-maxillary gland, 
structures around the chin, the internal pterygoid, 
and stylo-hyoid muscles. On the face it supplies the 
masseter and buccinator muscles, lower and upper 
lips, mucous membrane of both lips, side of the nose, 
the inner angle of the eye, and root of the nose. 



ANATOMY. 2 99 

Give origin and course of three principal divisions 
of the fifth pair of nerves. 

Origin. — From the Gasserian ganglion, sitnated 
at the apex of the petrons portion of the temporal 
bone ; its three divisions are : first, ophthalmic which 
traverses the craninm through the sphenoidal fissnre 
and goes to the region of the eye ; second, superior 
maxillary which leaves the cranium through the 
foramen rotundum, passes through the spheno-max- 
illary fossa and supplies the superior maxillary bone 
and surrounding structures ; third, inferior maxillary 
which leaves the cranium through the foramen ovale, 
passes downward, and, entering the dental canal, sup- 
plies the inferior maxillary bone and surrounding 
structures. 

Name the three classes of articulations. 

Synarthrosis, amphiarthrosis and diarthrosis. 
What nerves pass through the spenoidal fissure ? 

The third, fourth, three branches of the ophthal- 
mic division of the fifth, and the sixth cranial 
nerves. 

Mention the muscles attached to the superior max= 
illary bone. 

Orbicularis palpebrarum, inferior oblique, leva- 
tor labii superioris alaeque nasi, levator labii superi- 
ors, levator anguli oris, compressor naris, depressor 
alae nasi, dilator naris posterior, masseter, buccin- 
ator, internal pterygoid, and orbicularis oris. 



JOO 



ANATOMY. 



Give the articulation of the lachrymal bone. 
Give the name of the muscle attached to this bone. 

It articulates with the frontal, superior max- 
illary, ethmoid, and inferior turbinated bones. The 
tensor tarsi muscle is attached to the bone. 
Describe the external jugular vein. 

It receives the greater part of blood from the ex- 
terior of the cranium and deeper part of the face, 
being formed by the posterior division of the tem- 
poro-m axillary and posterior auricular veins. It be- 
gins in the parotid gland on a level with the angle of 
the lower jaw, extends down the neck on, a line drawn 
from the angle of the lower jaw to the middle of the 
clavicle, lies in the platysma, and empties into the 
sub-clavian vein. 

Describe the common carotid artery. 

The common carotid artery in the neck, extends 
from the sterno-clavicular joint upward and back- 
ward in the carotid sheath, to the level of the upper 
border of the thyroid cartilage, where it bifurcates 
into its internal and external branches. In company 
with it, may be found the internal jugular vein and 
the pneumogastric nerve. The right common carotid 
is a derivative of the innominate, whilst the left is a 
branch of the arch of the aorta. The right begins 
behind the sterno-clavicular articulation ; the left lies 
deeply placed, overlapped by the left lung and pleura. 
Higher up, it lies beneath the sterno-hyoid and sterno- 
thyroid muscles. The artery on the right is 9. 5 cm. 
long; on the left, 12 cm. 



ANATOMY. joi 

Mention the branches of the hypoglossal nerve. 



Coranmmcating 
branches to 



pneumogastric, 

sympathetic, 

one to two cervical nerves, 

lingual. 

meningeal, 
Distributing j descendens hypo-glossus, 

thyro-hyoid, 
muscular. 



branches are 



Define osteology. 

Osteology is the science which treats of the 
structure, development and function of bones. It is 
that part of anatomy which treats of bones. 

What bones enter into the formation of the orbi- 
tal cavities ? 

The bones entering into the formation of the 
orbital cavity are the frontal, sphenoid, lachrymal, 
ethmoid, superior maxilla, malar, and palate bones. 

Describe the frontal bone and give its articula- 
tion. 

The frontal bone is situated at the fore part of 
the cranium and may be said to possess two portions : 
viz., a vertical and a horizontal plate. Internally on 
the vertical plate, may be seen the following : — a 
groove in the median line for the lodgment of the su- 
perior longitudinal sinus, the margin of the groove 
serving for the attachment of the falx cerebri. The 
foramen caecum, for the passage of a small vein to 
the sinus. Elevations and depressions accommoda- 



J02 ANATOMY. 

ting cerebral convolutions. Externally, — the frontal 
eminences located on either side of the midline ; the 
remains of the metopic suture ; two converging super- 
ciliary ridges ; the convergence marking the nasal 
eminence, behind which are located the frontal 
sinuses ; the supra-orbital ridges, terminating inter- 
nally in the internal angular, and externally in the 
external angular processes. Between the internal 
angular processes is noted the nasal notch, from the 
middle of which projects the nasal spine. The hori- 
zontal plate consists practically of the two orbital 
plates, separated by an interval known as the ethmoi- 
dal notch, which shows on its margins the anterior 
and posterior ethmoidal foramina. The notch re- 
ceives the cribriform plate of the ethmoid bone. 
The upper surfaces of the orbital plates show ridges 
and depressions to accommodate the convolutions of 
the cerebrum. The inferior surface of each plate is 
smooth, serving as the roof of the orbital cavity, 
marked to the inner side by a small depression, 
called the trochlear fossa, for the pulley of the 
superior oblique muscle ; and just within the exter- 
nal angular process is seen the lachrymal fossa, for 
the lodgment of the lachrymal gland. The frontal 
bone articulates with the parietal, sphenoid, ethmoid, 
lachrymal, malar, superior maxillary, and nasal 
bones. The frontal also articulates with epipteric 
bones when they are present. 

Describe the temporal bone. 

The temporal bone is located at the lateral and 
in part the basal area of the skull and consists of 



ANATOMY. 



303 



three portions, viz., squamous, mastoid and petrous. 
The squamous portion of the bone is marked inter- 
nally by grooves for the meningeal arteries and by 
depressions for brain convolutions. Externally, this 
scale-like portion of the bone shows a zygomatic pro- 
cess going forward to articulate with the malar bone. 
The process arises by three roots ; the posterior, con- 
tinuous with the temporal ridge ; the middle, extend- 
ing at the post-glen oid tubercle ; and the anterior, 
dipping at right angles to join the eminentia articu- 
laris. 

Inferiorly, the squamous portion of the temporal 
bone exhibits a fossa, called the glenoid fossa, which 
articulates with the condyle of the inferior maxillary 
bone. In front of this fossa is seen the eminentia 
articularis, a rounded bony mass. Dividing the fossa 
transversely is the Glasserian fissure, which trans- 
mits the laxator tympani muscle, the tympanic 
branch of the internal maxillary artery, and lodges 
the processus gracilis of the malleus. A narrow sub- 
division of this fissure is called the canal of Huguier. 

The mastoid portion of the bone projects, nipple-like, 
downward. Internally, a well-marked groove, called 
the fossa sigmoidea, is seen, which lodges the termi- 
nal portion of the lateral sinus. Externally, are seen 
the mastoid tip, for the insertion of the sterno-mastoid, 
splenitis and trachelo-mastoid muscles ; digastric fossa, 
for the attachment of the digastric muscle ; the occi- 
pital groove, for the occipital artery. On section the 
bone shows a series of cells opening into the tympan- 



3<>4 



ANATOMY. 



urn, The petrous portion of trie bone exhibits a base, 
marked by the meatus auditorius externus; an apex 
which assists in the formation of the foramen lacerum 
medius; an anterior surface, showing from within 
outward, the opening of the carotid canal ; a depres- 
sion lodging the Gasserian Ganglion ; two small 
openings, the larger called the Hiatus Fallopii, the 
smaller unnamed, transmitting respectively the greater 
and lesser petrosal nerves ; an eminence marking the 
superior semi-circular canal, and a translucent plate 
of bone, the tegnien tympani, overlying the tympanum. 
The posterior surface is marked by the meatus auditor- 
ious internus, transmitting the 7th and 8th nerves, 
together with a small auditory artery. To the outer 
side and below the meatus auditorus internus a small 
slit is seen, the aqueductus vestibuli, which transmits 
in early life the ductus endo-lymphaticus. The in- 
ferior surface of the bone is marked from within out- 
ward, by the following : a rough surface, for the 
attachment of the tensor tympani and levator palati 
muscles ; a large opening, the carotid foramen, the 
beginning of a canal of the same name, transmitting 
the internal carotid artery. Now, a triangular depres- 
sion is seen, at the bottom of which is the aqueductus 
cochleae, transmitting a loop of vessels to the cochlea. 
Next, an irregular fossa, called the jugular fossa, on 
the outer wall of which is seen the auricular canal, 
transmitting Arnold's nerve (auricular branch of the 
10th). On the ridge between the carotid opening and 
jugular fossa is seen the tympanic canal for the trans- 
mission of Jacobson's nerve (tympanic branch of 9th). 



ANATOMY. 



305 



To the outer side of the jugular fossa is located the 
styloid process, for the attachment of the stylo-hyoid, 
stylo-glossus and stylo-pharyngeus muscles, and the 
stylo-hyoid and stylo-maxillary ligaments. The open- 
ing alongside of the process is called the stylo-mastoid 
foramen, transmitting the facial nerve and the stylo- 
mastoid artery. The petrous portion of the bone con- 
tains the tympanum and the aqueductus Fallopii, 
(live the articulations of the temporal bone. 

The temporal bone articulates with the occipital, 
parietal, sphenoid, inferior maxillary and malar bones. 

From how many centres is the temporal bone de= 
veloped ? 

The temporal bone is developed from ten centers. 
One for the squamous portion and zygoma, one for 
the tympanic plate, six for the petrous and mastoid 
segments, and two for the styloid process. 

Describe the ophthalmic artery. 

It is a branch of the internal carotid, just as that 
vessel is emerging from the cavernous sinus on the 
inner side of the anterior clinoid process, and enters 
the orbit through the optic foramen below and to 
the outer side of the optic nerve ; crossing the nerve, 
it terminates at the internal angular process of the 
frontal bone, where it divides into the frontal and 
nasal branches. 

Describe the pulmonary veins. 

The pulmonary veins are those vessels which re- 
turn the arterial blood from the lungs to the left auri_ 



jo6 



ANATOMY. 



cle of the heart. They are four in number, two from 
each lung. The pulmonary veins differ from the 
other veins in several respects ; first, they carry arte- 
rial blood instead of venous blood ; second, they have 
no valves ; third, they are slightly larger than the 
arteries they accompany. They commence in a capil- 
lary network upon the wall of the air cells, where 
they are continuous with the capillary ramification of 
the pulmonary artery, and together form branches 
which converge to form a single vessel from each 
lobe, with the exception that the branch from the 
middle lobe of the right lung empties in the upper of 
the two right pulmonary veins. 

Describe the Otic Ganglion. 

It is a small oval flattened ganglion of a reddish- 
gray color, situated immediately below the foramen ov- 
ale, on the inner surface of the inferior maxillary nerve. 
It receives motor and sensory roots from the inferior 
maxillary division of the fifth nerve. The small su- 
perficial petrosal nerve also enters the ganglion as a 
motor root. It receives its sympathetic root from the 
plexus surrounding the middle meningeal artery. 

Give a brief description of the facial nerve. 

This nerve is the motor nerve to the muscles of 
expression in the face. 

Its superficial origin is from the pons at its lower 
border to the inner side of the eighth nerve. It arises 
deeply from a nucleus beneath the floor of the fourth 
ventricle in its upper half. It leaves the cranial 
cavity through the internal auditory meatus, then 



ANATOMY. joy 

passes above the crista falciformis through an opening 
in the lamina cribrosa, called aqueductus Fallopii, 
then passes through a canal in the petrous portion of 
the temporal bone and gives off in this canal a great 
and small petrosal ; leaving the temporal bone 
through the stylo-mastoid foramen, it passes through 
the parotid gland, downward around the angle of the 
jaw and up across the masseter muscle and breaks 
up into filaments to supply the muscle. 

Describe the hypoglossal nerve. 

It is the motor nerve to the tongue. Its superfi- 
cial origin is from the side of the medulla oblongata 
in the groove between the pyramidal and olivary 
bodies. Its deep origin is from the grayimatter on 
the floor of the fourth ventricle. It passes out of the 
cranium through the anterior condyloid foramen to 
the base of the tongue, and along the tongue to the 
tip which it supplies. It gives off communicating 
branches to, 

Pneumogastric. — First and second cervical 
nerves. 

Sympathetic. — Lingual. 
The branches of distribution are : 
Meningeal. — Thyro-hyoid. 
Descendens Hypoglossis. — Muscular. 

Describe the outer surface of the occipital bone. 

It is convex ; and, midway between the superior 
angle and posterior border of the foramen magnum, 
is the external occipital protuberance. Extending 
towards the lateral angular process from the external 



jo8 ANATOMY. 

occipital protuberance are the superior curved lines 
of the occipital bone. Passing from this protuber- 
ance to the foramen magnum is the external occipital 
crest. Midway between the foramen magnum and the 
protuberance, extending parallel with the superior 
curved lines, are the inferior curved lines. The por- 
tion of bone above the superior curved lines is smooth; 
over it glides the occipital frontalis muscle. The 
bone between the lines and the foramen magnum is 
rough for the attachment of muscles. 

Describe the inner surface of the frontal bone. 

It is concave, smooth, and contains eminences and 
depressions for the reception of convolutions of the brain. 
In the median line is the groove for the lodgment of the 
superior longitudinal sinus. At the outer part of the 
median line above the external notch is the foramen 
caecum. When open, it transmits a small vein ; 
above this is a sharp crest of bone, called the frontal 
crest, which gives attachment to part of the falx 
cerebri. 

Describe the nasal bone and give its articulations. 

It is a flat bone situated at the root of the nose, 
helping to form the bridge of the nose. It presents 
two surfaces and four borders. The external surface 
is concave from above downward and slightly con- 
vex from side to side. It is covered by the com- 
pressor nasi and pyramidalis nasi muscles. The 
internal surface presents a groove, the nasal groove, 
transmitting the nasal nerve. Its superior border 
articulates with the nasal notch of the frontal bone. 



ANATOMY. 3 og 

the anterior border articulates with its fellow ; and, 
on the inner edge of the inner border, it also articu- 
lates with the perpendicular plate of the ethmoid. 
The posterior border articulates with the superior 
maxillary bone ; its superior border is rough for 
articulation with the nasal notch of the frontal bone. 
It gives attachment to the cartilage of the nose. 

What is an aponeurosis ? 

It is a broad and expanded portion of a tendon, 
consisting of white fibrous tissue ; it may connect 
two bellies of muscles, as, occipital frontalis. 

Give origin and insertion of each of the muscles 
of the palpebral region. 

Four ; orbicularis palpebrarum, corrugator su- 
percilii, levator palpabrae and tensor tarsi. Orbic- 
ularis palpebrarum, orgin, — internal angular pro- 
cess of the frontal bone, and nasal process of the 
superior maxillary and tendon oculi, passes out- 
ward around the circumference of the orbit and 
is inserted, — some fibres into the tarsal ligaments, 
oftener, fibres form a complete ellipse ; the re- 
maining fibres blend in with the surrounding mus- 
cles. Corrugator supercilii ; origin, — from the inner 
extremity of the superciliary ridge, passing out to be 
inserted into the skin. Levator palpabrae ; origin, — 
under the surface of the lesser wing of the sphenoid 
above and in front of the optic foramen. It passes 
outward along the roof of the orbit, becoming aponeu- 
rotic, and it is inserted into the upper margin of the 
superior tarsal plate. Tensor tarsi ; origin. — from the 
crest and adjacent part of the orbital surface of the 



jio ANATOMY. 

lachrymal bone, extendiug across the lachrymal sac, 
it is divided into two tendons to be inserted into the 
tarsal plates. 

Mention the muscles of the tongue. 

Genio-hyo-glossus, hyo-glossus, stylo-glossus, 
palato-glossus, chondro-glossus. 

Give the origin, insertion and nerve supply of the 
styloglossus muscle. 

The origin from the anterior and outer side of 
the styloid process near its apex, passing downward 
and forward it is inserted into the side of the tongue. 

Nerve, the hypoglossal. 

Describe the middle cerebral artery. 

It is a large branch of the internal carotid, passes 
obliquely outward along the fissure of Sylvius and 
opposite the island of Reil, divides into terminal 
branches. It gives off the following branches : An- 
terolateral ganglionic^ inferior external frontal, par- 
ietotemporal, ascending frontal, ascending parietal. 

/ Bound the superior carotid triangle (triangle of 

election). 

It is bound anteriorly and above by the posterior 
belly of the digastric and stylo-hyloid muscles ; 
bounded posteriorly by the anterior margin of the 
sterno-mastoid muscle ; anteriorly and inferior^, b} T 
the superior border of the omo-hyoid muscle. 
Describe the superior longitudinal sinus. 

It occupies the attached margins of the falx cere- 
bri ; begins at the foramen caecum of the frontal 



ANATOMY. j ii 

bone, passes vertically upward and backward, groov- 
ing the inner surface of the frontal and adjacent 
edges of parietal and inner sides of occipital bone, 
and teminates by opening into the torcular Herophili. 
It is triangular inform, narrow in front, gradually in- 
creasing in size as it passes backward. 

Describe the subclavian vein. 

It is a continuation of the axillary ; extends from 
the outer border of the first rib to the inner end of 
the clavicle, where it unites with the internal jugular 
to form the innominate vein. 

The subclavian vein lies anterior to the correspond- 
ing artery, and in the second part of its course is 
separated from the artery by the scalenus anticus 
muscle. Near the point where the external jugular 
empties a pair of valves is seen. 

Describe the submaxillary ganglion. 

It is a very small ganglion situated above the 
deep portion of the submaxillary gland, being connect- 
by filamants with the lower border of the lingual 
nerve. It also communicates with the corda tympani, 
and the s} T mpathetie plexus around the facial artery. 

Describe the ophthalmic nerve. 

It is the first division of the fifth, sensory in 
function arising, from the upper part of the Gasserian 
ganglion and leaves the cranium through the sphe- 
noidal fissure, and divided into three branches, — the 
frontal which supplies the eyebrow, forehead and 
nose; the lachrymal which supplies the lachrymal 



j 12 ANATOMY. 

gland; and the nasal which supplies the mucous 
membrane and septum of the nose. 

Name the arteries and nerves of the gums. 

The gums receive blood supply from the vas- 
cular mucous membrane covering them, and from 
terminal branches of the internal maxillary. The 
nerve supply is from the branches of the superior 
and inferior maxillary divisions of the fifth and fila- 
ments from Meckel's ganglion. 

What bones encase the brain and what is their 
relative position ? 

Occipital, two parietal, ethmoid, frontal, and 

sphenoid. The occipital bone is in the back part of 

the head ; the parietal bones form the top of the 

head ; the temporal bones are at the sides of the 

head ; sphenoid and ethmoid form part of the base of 

the skull ; the frontal bone forms the front part of the 

head and also enters into the formation of the orbit. 

What is the structural difference between an 
artery and a vein ? 

The main difference is in the middle coat of the 
vessels, which is much weaker in the veins than in 
the arteries, and which allows the veins to collapse 
when divided. Veins have valves, whilst the arteries 
have none. 

Describe the spinal column. 

The spinal column is a flexible column formed 
by a series of bones of which there are 33 in number. 
They are named, according to the position they occupy, 
cervical, dorsal, lumbar, sacral, and coccygeal. The 
column is situated in the median line at the posterior 



ANATOMY. j/j 

of the trunk ; its average length is seventy centime- 
tres (70 cm), and it contains the spinal cord. 
What are tendons and their function ? 

They are white glistening cords or bands com- 
posed almost entirely of white fibrous tissue ; they 
have but few vessels, no nerves, and serve to connect 
the muscles with the structures upon which they 
act. 

Describe the elbow joint and the manner of its 
lubrication 

It is a ginglymus articulation formed by the 
lower end of the humerus with the greater sigmoid 
cavity of the ulna and the head of the radius. It has 
four ligaments, viz : anterior, posterior, external and 
internal lateral. It is lubricated by the endothelial cells 
which line the synovial membrane and which secrete 
the synovial fluid. 

Describe the knee joint and its manner of lubri= 
cation. 

It is a ginglymus articulation formed by the con- 
dyles of the femur with the head of the tibia and the 
patella in front. It has fourteen ligaments, of which 
six are external and eight are internal. The liga- 
ments are as follows : Anterior or ligamentum 
patella ; posterior, or ligamenta Winslowii ; in- 
ternal lateral, two external lateral, capsular, an- 
terior crucial, posterior crucial, two semi-lunar fibro 
cartilages, transverse, coronary, ligamentum mucosum 
and ligamenta alaria. It is lubricated by the endo- 
thelial cells which line the synovial membrane and 
which secrete the synovial fluid. 



j 14 ANATOMY. 

What muscles are involved in respiration ? 

Diaphragm, external and internal intercostal, 
infracostals, pectoralis minor, rhomboideus, trapezius, 
serratus magnus. 

Describe the osseous structure which protects the 
thorax. 

It is an osseo-cartilaginous cage, formed by the 
dorsal vertebrae posteriorly, the ribs and costal cartil- 
ages laterally, and the sternum in front. 

Give the muscles of facial expression. 

Risorius, levator labii superioris alaeque nasi, 
orbicularis, depressor anguli oris, depressor labii in- 
ferioris, buccinator, platysma myoides, zygomaticus 
major and minor, levator labii superioris. 

Describe the joint in which the lower maxilla' 
works and the tissues constituting the joint. 

It is a double arthrodial joint. The parts enter- 
ing into the formation are : above, the anterior part 
of the glenoid cavity of the temporal bone and eminen- 
tia articularis ; and below, the condyle of the lower jaw. 
The ligaments entering into the formation of this joint 
are : internal and external lateral, stylo-maxillar}^ 
capsular, inter-articular fibro cartilage. Two synovial 
membranes are placed, one above and one below the 
fibro articular catilage. ( 1 ) The external lateral liga- 
ment is attached above to the outer surface of the 
zygoma and tubercle adjacent, and is inserted into the 
outer surface of the posterior border of the neck of the 
lower jaw. (2) The internal lateral ligament extends 
from the inner margin of the glenoid fossa, and spine 



ANATOMY. 



3 J 5 



of the sphenoid, to the inner aspect of the neck of the 
condyle. (3) The stylo-maxillary, extends from the 
apex of the styloid process of the temporal bone and 
is attached to the angle and posterior border of the 
ramus of the lower jaw, between 1 the masseter and in- 
ternal pterygoid muscles. (4) The capsular is attached 
to the circumference of the glenoid cavity. (5) The 
inter-fibro-articular cartilage is placed between the 
condyle of the jaw and the glenoid cavity. 

Name the bones of the head and face and give the 
articulation of the superior maxillary. 

Head : — Occipital, two parietal, two temporal, 
frontal, sphenoid, ethmoid. Face : — Two lachrymal, 
two malar, two turbinated, vomer, two superior max- 
illary, two palate, inferior maxillary, two nasal. The 
superior maxillary articulates with nine bones, viz : — 
frontal, ethmoid, nasal, malar, lachrymal, inferior tur- 
binated, palate, vomer, and with its fellow of the op- 
posite side. 

Give the origin, insertion, nerve supply and action 
of the gastrocnemius muscle. 

It arises by two heads, — the inner head, which 
is the larger and a little more posterior, arises from 
a depression at the upper and back part of the inter- 
nal condyle of the femur ; the outer head arises from 
the external condyle of the femur, the converging 
heads forming a fleshy belly to be inserted into the os 
calcis by the tendo Achilles. The nerve is the inter- 
nal popliteal, and the action is to extend the foot. 

What structures pass through the foramen mag= 
num. 



ji6 ANATOMY. 

The foramen magnum transmits the medulla 
oblongata and its membranes, spinal accessory nerves, 
the vertebral arteries, posterior spinal arteries and the 
occipito-axial ligaments. 

What is a mucous membrane, serous membrane ? 
Give example of each. 

A mucous membrane is a soft, velvety structure; it 
consists of epithelial cells which rest upon a basement 
membrane and secrete a fluid called mucus. It com- 
municates with the exterior of the body. A serous 
membrane is also a soft, velvety structure ; it consists 
of endothelial cells which rest upon a basement mem- 
brane, but does not communicate with the exterior of 
the body, e. g. mucous membrane of the mouth, serous 
membrane of the peritoneum. 

Name the principal muscles involved in mastica= 
tion and give the origin and insertion of two. 

Masseter, temporal, internal and external ptery- 
goid. The masseter muscle arises from the anterior 
two-thirds and inner surface of the zygoma and malar 
process of the superior maxillary, and is inserted into 
the angle, ramus and coronoid process of the lower 
jaw. The temporal muscle arises from the temporal 
fossa, and fascia, and is inserted into the anterior bor- 
der and inner surface of the coronoid process of the 
inferior maxillary bone. 

Describe the occipital bone and give its articu= 
lations. 

It is situated in the back part and the base of 
the cranium, and presents for examination two sur- 



ANATOMY. 



3*7 



faces, four borders and four angles. On its external sur- 
face there is a protuberance which affords attachment 
for the ligamentuni nuchas, also curved lines for the 
attachment of muscles. The internal surface is di- 
vided into a ridge and four fossae which lodge the 
occipital lobes of the cerebrum, and the hemispheres 
of the cerebellum. It also presents a protuberance 
similar to the one on the external surface, called the 
internal occipital protuberance. Posterior to the 
basilar process of the occipital bone is the foramen 
magnum. The occipital bone articulates with six 
bones, viz., two parietal, two temporal, atlas and 
sphenoid. 

Describe the shoulder joint with its integuments. 

It is an enarthrodial or ball and socket joint. 
The bones entering into its formation are two in num- 
ber, — the large head of the humerus which is received 
into the glenoid cavity of the scapula. The ligaments 
are the capsular, glenoid, transverse humeral, coraco- 
humeral. The capsular ligament encircles the glenoid 
cavity. The glenoid ligament is a fibro-cartilaginous 
rim attached to the margin of the glenoid cavity. The 
transverse humeral ligament is a broad band of 
fibrous tissue passing from the lesser to the greater 
tuberosity of the humerus. The coraco-humeral lig- 
ament strengthens the upper part of the capsular 
ligament. 

What muscles move the lower jaw ? Give origin 
and insertion. 

Temporal, masseter, digastric, genio-hyoid, mylo- 
hyoid, platysma myoides, external and internal 



ji8 ANA TO MY. 

pterygoid. The temporal arises from the temporal 
fossa and fascia, and is inserted into the coronoid pro- 
cess of the lower jaw. The masseter arises from the 
anterior two-thirds and inner surface of the zygoma 
and malar process of the superior maxillary, and is 
inserted into the angle, ramus, and coronoid process 
of the lower jaw. The digastric arises by two bellies- 
posterior, from the mastoid process of the temporal 
bone ; the anterior, from the fossa on the inferior 
maxillary near the symphysis, and is inserted into the 
central tendon, perforating the stylo-hyoid muscle and 
being bound down to the hyoid bone by aponeurotic 
loops. The genio-hyoid arises from the inferior genial 
tubercle of the inferior maxillary and is inserted into 
the hyoid bone. The mylo-hyoid arises from the 
mylo-hyoid ridge and is inserted into the hyoid bone. 
The platysma-myoides arises from the cellular tissue 
and integuments below the clavicle and is inserted 
into the chin and fascia of the lower jaw. The in- 
ternal pterygoid arises from the internal surface of 
the external plate of the pterygoid process, and is in- 
serted into the angle and inner surface of the ramus 
as high as the dental foramen. The external ptery- 
goid arises from the external surface of the external 
plate of the pterygoid process of the sphenoid bone, 
pterygoid ridges, and tuberosities of the palate and 
superior maxillary bones, and is inserted into a de- 
pression in front of the condyle of the lower jaw and 
inter-articular fibro cartilage. 

Describe the superior maxillary bone and give 
its articulations. 



ANATOMY. ji 9 

The superior maxillary bone, with its fellow, forms 
a large part of the face. It presents for examination 
a body with nasal, malar, alveolar and palate pro- 
cesses. On ;the body may be noted four surfaces 
The facial, or anterior surface, presents a well-marked 
ridge of bone, the canine eminence. In front 
of the canine eminence is a depression, called the 
incisive fossa. Internally, this fossa is limited by a 
rounded border, which terminates in a process in the 
median line, called the nasal spine. Above the 
canine fossa is seen the infra-orbital foramen, which 
is the termination of the infra-orbital canal, transmit- 
ting the vessels and nerves of the same name. 

The posterior, or zygomatic surface, forms part 
of the zygomatic fossa. About its centre are seen 
several apertures leading into the posterior dental 
canals. Inferiorly, is the maxillary tuberosity, rough 
internally for articulation with the palate bone. By 
articulating with the palate bone, a posterior groove 
is converted into the posterior palatine canal. 

The superior, or orbital surface, forms part of 
the floor of the orbital cavity. Along the middle 
of this surface is seen a deep groove, called the infra- 
orbital groove, leading into a canal of the same name ; 
this is subdivided, transmitting the infra-orbital nerve 
and its anterior dental branches. 

The internal surface is unequally divided into 
two parts by the palate process ; the portion above 
the process forms part of the outer wall of the nasal 
fossa ; that below, forms part of the oral cavity. 



3 20 ANATOMY. 

Superiorly, the opening into the antrum of High- 
more is seen. 

The malar process is a rough eminence, concave 
in front, forming part of the facial surface ; behind, 
the concavity forms part of the zygomatic fossa. 
The nasal process anteriorly is serrated for articula- 
tion with the nasal bone. Behind, it is smooth, 
articulating with the lachrymal bone. The surface 
presents superior and inferior turbinated crests ; the 
former articulating with the middle turbinated pro- 
cess of the ethmoid. 

On the posterior border is seen a groove, which 
assists in forming the nasal duct. The alveolar pro- 
cess, curved, presents the alveoli, or sockets for the 
teeth. The palate process forms part of the floor 
of the nasal cavity and the roof of the mouth. 

It presents, just behind the incisor teeth, a 
fossa, the anterior palatine fossa, at the bottom 
of which are seen four small foramina, two placed 
laterally, the foramina of Stenson, two antero- 
posterior^, the foramina of Scarpa. The fora- 
mina of Stenson transmit the anterior palatine 
arteries, whilst the foramina of Scarpa transmit the 
anterior palatine nerves. 

The superior maxillary bone articulates with the 
frontal, ethmoid, vomer, nasal, lachrymal, malar, 
palate, inferior turbinated, and with its fellow. 

Give origin, insertion, nerve supply, and action of 
the omo=hyoid muscle. 



ANATOMY. 



3 21 



It arises from the upper border of the scapula 
and transverse ligament (converts the supra-scapu- 
lar notch into a foramen), and passes forward and 
slightly upward across the lower part of neck, be- 
coming tendinous back af the sterno-mastoid muscle, 
and is bound down by a loop of the cervical fascia. 
The anterior belly forms an obtuse angle with its 
posterior belly, and passes upward to be inserted into 
the lower border of the body of the hyoid bone. 
Nerve supply — Branches from the loop of communi- 
cation between the descendens and communicans 
hypoglossi. Action — Depresses the hyoid bone, car- 
ries it backward and to the side. 

Give the origin, insertion, nerve supply and 
action of the genio=hyo=glossus muscle. 

It arises from the superior genial tubercles, 
passes backward and downward to be inserted into 
the under surface of the tongue, and body of the 
hyoid bone. It receives its nerve supply from the 
hypoglossal. Its action is to draw back the tip and 
create a dorsal transverse concavity, to draw the dor- 
sum at the back part forward, to protrude the tongue, 
and to assist in raising the hyoid bone. 

Describe the superior thyroid artery. 

It is the first branch given off from the external 
carotid just below the great cornu of the hyoid bone. 
It passes upward and inward, then, curving down- 
ward and forward in an arched and tortuous manner, 
proceeds to the upper part of the thyroid gland, pass- 
ing beneath the omo-hyoid, sterno-hyoid and sterno- 
thyroid muscles, and supplying them. It gives off 



322 ANATOMY. 

the following branches ; hyoid, sterno-rnastoid, su- 
perior laryngeal and crico- thyroid. 

Describe the mylo=hyoid nerve. 

It is a branch of the inferior dental just as the 
nerve is about to enter the inferior dental canal ; it 
descends in a groove on the inner side of the jaw and 
supplies the mylo-hyoid, and anterior belly of the 
digastric muscles. 

Describe the os planum. 

It is a flat smooth surface situated on the outer 
surface of the lateral mass of the ethmoid bone. It 
is quadrilateral in outline, helping to form the inner 
wall of the orbital cavity. The superior border articu- 
lates with the frontal, the anterior border with the 
lachrymal, the inferior border with the superior 
maxilla and palate, and the posterior border with the 
sphenoid. 

riention the number of points of ossification of 
the inferior maxillary bone, and describe its development. 

Five centres of ossification. 
The lower jaw is developed principally 
from membrane, but partly from cartilage. The pro- 
cess of ossification commences earlier than in any 
other bone except the clavicle. The dentary centre of 
ossification appears between the fifth and sixth week 
in the membrane on the outer surface of Meckel's 
cartilage. The splenial centre appears in the mem- 
brane on the inner surface of Meckel's cartilage and 
from this centre the inner wall of the sockets of the 
teeth is formed. The anterior extremity of Meckel's 



ANATOMY. J2J 

cartilage becomes ossified forming the body of the 
bone on each side of the symphysis. A separate patch 
of cartilage appears at the condyle, and one at the 
angle, in each of which is a separate centre of ossifi- 
cation. The coronoid process is also ossified from a 
separate centre. At birth the bone consists of two 
halves united by fibrous symphysis, which ossifies 
during the first year. 

Give origin, insertion, nerve supply and action of 
the digastric muscle. 

This muscle consists of two fleshy bellies united 
by a rounded tendon. The posterior belly, longer 
than the anterior, arises from the digastric groove on 
the inner side of the mastoid portion of the temporal 
bone and passes downward, forward and inward. The 
anterior belly arises from a depression on the inner 
side of the lower border of the inferior maxillary, 
close to the symphysis, and passes downward and 
backward to join the posterior belly by a rounded 
tendon which perforates the stylo-hyoid muscle and is 
bound down to the hyoid bone by a fibrous loop lined 
by synovial membrane. The posterior belly is sup- 
plied by the facial nerve and the anterior belly by the 
mylo-hyoid nerve. Action : With the posterior belly 
fixed and the hyoid bone depressed, it acts by de- 
pressing the inferior maxilla. The attachment of the 
anterior belly being fixed, it raises the hyoid bone. 

Give the articulation of the ethmoid. 

It articulates with 15 bones, viz. : Sphenoid and 
frontal of the cranium, all the bones of the face ex- 



3H 



A NATO MY. 



cept the two malar and inferior maxillary bone, and 
with the two. sphenoidal turbinated bones. 

flention the muscles of mastication and give their 
origin and insertion. 

Temporal : Origin, temporal fossae ; insertion, 
coronoid process and the whole length of the anterior 
border of the ramus of the inferior maxilla. 

Masseter : Origin, two heads, — the deep, from 
the inner inferior surface of zygomatic process of the 
temporal bone ; the superficial, from the zygoma and 
malar bone. Insertion, on the outer side of the ramus 
of the inferior maxilla. 

External pterygoid : Origin, two heads. — the 
long head, from the pte^goid ridge and under sur- 
face of the great wing of the sphenoid bone ; the 
short head, from the ^external surface of the pterygoid 
plate of the sphenoid bone. Insertion, — into a fossa 
on the anterior border of the neck of the condyle of 
the lower jaw and interarticular fibro cartilage of the 
temporo-maxillary articulation. 

Internal pterygoid : Origin, from the pteiygoid 
fossae ; insertion, into the inner side of the ramus 
and angle of the inferior maxilla. 

Buccinator : (Is sometimes described as a muscle 
of mastication). Origin, from the alveolar process 
above the upper and below the lower molar teeth and 
the anterior border of the pterygo-maxillary ligament. 
Insertion, into the orbicularis oris muscle at the angle 
of the mouth. 



ANATOMY. 325 

Mention the muscles attached to the hyoid bone. 

Sternohyoid, thyro-hyoid, omohyoid, aponeurosis of 
digastric, stylo-hyoid, mylo-hyoid, genio-hyoid, genio- 
hyo-glossus, chondro-glossus, hyo-glossus, middle 
constrictor of the pharynx, and sometimes a few fibres 
of the inferior lingualis. 

Describe the aorta. 

It is this main artery that conveys the pure blood 
to the tissues of the body for nutrition. This vessel 
commences at the upper part of the left ventricle, as- 
cends a short distance to the right of the vertebral 
column, then arches backward and to the left side 
over the root of the left lung, and then descends into 
the thorax on the left side of the vetrebral col- 
umn, passes through the aortic opening in the diaph- 
ragm, enters the abdominal cavity, and terminates op- 
posite the lower border of the fourth lumbar vertebra. 
Here it divides into the right and left common iliac 
arteries. It is divided into the ascending aorta, the 
arch of the aorta, the descending aorta, thoracic aorta 
and abdominal aorta. 

Describe the superior vena cava. 

It receives the blood from the upper half of the 
body and conveys it to the heart. It is seven or eight 
centimetres in length and is formed by the junction 
of the two innominate veins. It commences immedi- 
ately below the cartilage of the first rib, close to the 
sternum on the right side, enters the pericardium, 
and empties into the right auricle of the heart. 

Describe the fissure of Rolando and give its 
location. 



j 26 ANATOMY. 

It is situated about the middle of the outer sur- 
face of the cephalic hemisphere. It commences near 
the longitudinal fissure and terminates a little above 
the horizontal limb of the fissure of Sylvius, running 
obliquely downward and forward. 

Describe the inferior maxillary nerve. 

The inferior maxillary nerve is formed by two 
parts, viz.: the entire motor root of the fifth nerve, and a 
group of fibers sent from the sensory root through 
the Gasserian ganglion. These bundles pass through 
the foramen ovale and unite on the outside of the 
cranium to constitute a trunk which in turn speedily 
divides into an anterior and a posterior portion. 

The anterior, the smaller, and which receives 
nearly the whole of the motor root, divides into 
branches that supply the muscles of mastication — 
the masseter, deep temporal, buccal and pterygoid. 

The posterior trunk which is the largest and for 
the most part sensory, but which receives a few fila- 
ments from the motor root, divides into three branches, 
auriculotemporal, lingual, and inferior dental. 

Mention the muscles attached to the sphenoid 
bone. 

Temporal, external pterygoid, internal pterygoid, 
superior constrictor, tensor palati, levator palpebrae 
superioris, superior rectus, internal rectus, inferior 
rectus, superior oblique, and external rectus. 
Describe the Vidian nerve. 

The vidian nerve is formed by the union of the 
large superficial petrosal branch of the facial and the 



ANATOMY, 



3 2 7 



large deep petrosal branch of the carotid plexus ; they 
join to form the nerve trunk in the cartilage which 
fills in the middle lacerated foramen. The nerve 
then passes forward through the vidian canal and 
joins the posterior angle of Meckel's ganglion, which 
is located in the spheno-maxillary fossa. 

flention the branches of the occipital artery. 

Muscular, sterno-mastoid, auricular, meningeal 
and arteria princeps cervicis. 

Describe the inferior maxillary bone. 

It is situated at the anterior and inferior part of 
the face and is the only movable bone of the skull. 
Presents for examination a horizontal part and two 
vertical portions. The horizontal part or body is 
shaped like a horse-shoe, presenting an external and 
internal surface, and two borders, — superior and 
inferior. 

The external surface presents the following 
points: — In the median line, the symphysis ; on each 
side of the symphysis, the incisive fossa, mental fora- 
men; external oblique line. 

Internal surface. — In the median line, four 
genial tubercles situated in pairs, on each side the 
lingual fossa, the internal oblique line, digastric de- 
pression, and the sub-maxillary fossa. 

The superior border or alveolar process presents 
sockets for the reception of eight teeth. 

The inferior border is rounded and smooth. 
Anteriorly is the attachment of the platysma, and 



j 2 8 ANATOMY. 

near the angle is a groove for the facial artery. The 
ramus is quadrilateral, and presents two surfaces and 
four borders. The external surface is rough for the 
insertion of the masseter muscle. The internal sur- 
face, presents in the center, the beginning of the in- 
ferior dental canal, a spine projecting from it, the 
lingula, for attachment of the internal lateral ligament 
of the lower jaw ; near the angle, a rough surface for 
insertion of the internal pterygoid muscle. 

The anterior border gives attachment in part to 
the temporal muscle ; and the posterior border gives 
attachment to the stylo-maxillary ligament ; while the 
superior border presents two processes separated by 
the sigmoid notch, the coronoid and condyloid. The 
coronoid process is sharp and thin and gives insertion 
to the temporal muscle. The condyle is an ovoidal 
process with a constricted portion called the neck. Its 
longest diameter is transversly or obliquely set on 
the neck. On the outer part of the neck is a pro- 
cess for the insertion of the tendon of the external 
pterygoid muscle. The inferior maxillary articulates 
with the two temporal bones. 

Describe the palatoglossus muscle. Give origin, 
insertion and nerve supply. 

Origin : From the anterior surface of the soft 
palate on each side of the uvula, it passes downward, 
forward and outward, and is inserted into the side of 
the tongue. 

Nerve supply : From the pharyngeal plexus 
formed by the vagus and glosso-pharyngeal nerves. 



ANATOMY. j 2 g 

Describe the facial surface of the superior maxil= 
lary bone and give the centre of ossification. 

It is slightly concave, presents above the incisor 
teeth the incisive fossae, for origin of the compessor 
nasi muscle ; to one side is the canine eminence, 
showing position of canine tooth ; a little above is the 
canine fossae, for the origin of the levator anguli oris 
muscle ; above this, is the infra orbital foramen 
through which passes the infra orbital vessels and 
nerves. Still more superiorly is a rough ridge for 
attachment of the lavator labii superioris muscle. 

The centres of ossification are four in number 
all of which are deposited in membrane. One for 
the facial surface, one for that portion about the infra 
orbital canal, one for the palatine process and one for 
the alveoli of the incisor teeth. 

Describe the internal jugular vein. 

It collects the blood from the interior of the cran- 
ium, and from the superficial portions of the face and 
neck. It begins at the jugular foramen, being formed 
by the union of the lateral and inferior petrosal sin- 
uses. It descends in the carotid sheath to the outer 
side of the internal carotid and common carotid arter- 
ies, and at the root of the neck, joins the subclavian 
vein to form the innominate vein. 

What muscles control the soft palate ? 

Tensor palati and levator palati. 

What are the terminal branches of the external 
carotid artery ? 

Temporal and internal maxillary. 



j jo ANA TO MY. 

Describe the maxillary sinus, (or antrum of High= 
more). 

It is a triangular shaped cavity situated in the 
body of the superior maxillary bone. Its base is 
toward the nasal' cavity, and its apex points towards 
the molar process. The roof is formed by the orbital 
surface of the bone, the anterior wall by the facial 
surface, and the floor by the alveolar process. It is 
sometimes divided into compartments by osseous 
septa. Extending along the posterior wall, is the pos- 
terior dental canal which transmits the posterior dental 
vessels and nerves ; and on the anterior surface is the 
anterior dental canal for its vessels and nerves. Some- 
times there are conical projections in the floor of the 
cavity as the result of the roots of the first and second 
molar teeth. The opening in the base is closed in by 
the palate, ethmoid and inferior turbinated bones, 
leaving a small orifice at the anterior and superior 
part to communicate with the middle meatus of the 
nose. 

What muscles depress the lower jaw ? 

Digastric, stylo-hyoid, mylo-hyoid and genio- 
hyoid. 
/ What forms the circle of Willis ? 

It is formed by nine arteries, viz. : — Two pos- 
terior cerebral, two posterior comimmicating, two in- 
ternal carotid, two anterior cerebral, and one anterior 
connecting. 

Describe the gustatory nerve. 

It is sometimes called the lingual nerve and is a 



ANATOMY. 33 r 

branch of the inferior maxillary division of the fifth. 
It passes down along the pterygoid muscles and then 
forward to the tongue. At the angle of the jaw, it is 
joined by the chorda tympani, which gives it special 
sense fibres. It supplies the mucous membrane and 
papillae of the anterior two-thirds of the tongue. 
What are the articulations of the malar bone ? 

With four bones,— -frontal, sphenoid, superior 
maxillary, and temporal. 

Name articulations of the occipital bone. 

With six bones, ---two temporal, two parietal, 
sphenoid and atlas. 

Describe the inferior maxillary artery and name 
its branches. 

It is generally called the inferior dental artery.lt is a 
branch of the first part of the internal maxillary ar- 
tery, and passes down and enters the inferior dental 
canal ; as it enter, it gives off the mylo-hyoid branch ; 
continuing downward, it turns horizontally forward at 
the angle occupying the canal in the body of the bone 
to one half inch in front of the mental foramen ; then, 
turning back, it forms a loop where the incisive 
branches are given off, and comes out of the mental 
foramen. After emerging, it gives off the mental 
and labial arteries. 

Name the muscles of the soft palate. 

Palato-glossus, palato-pharyngeus, azygos mus- 
cle, levator palati, tensor palati. 

What artery supplies the tongue with blood ? 

The lingual. 



33 2 



ANATOMY. 



Name the articulation of the temporal bone. 

Parietal, occipital, malar, sphenoid, and inferior 
maxillary. 

Name the muscles of the tongue and their attach- 
ments. 

Genio-hyo-glossus, hyo-glossus, stylo-glossns, 
palato-glossus, chondro-glossns : Origin, from the 
superior genial tubercle ; insertion, — hyoid bone and 
side of tongue. 



Hyo-glossus. 



{Origin, — great cornu of hyoid 
bone. 
Insertion, — side of tongue. 

f Origin, — styloid process of the 



Styly-glossus. \ 



temporal. 



j Insertion, — side of tougue, near 
[ the dorsal surface. 

f Origin, — base of lesser cornu of 

m. j i ! hyoid bone. 

Lnondro-glossus. -< T J ,, , .^ . . 

& j Insertion, — blends with intrinsic 

[_ muscular fibres of the tongue. 

{Origin, — soft palate on each side 
of uvula. 
Insertion, — side of tongue. 



Palato-glossus. 



Describe the lingual artery and give its branches. 

It is a branch of the external carotid, and arises 
between the facial and the superior thyroid. Passes 
upward and inward to the greater cornu of the hyoid 
bone and forward, crossed by the hypo-glossal nerve 
beneath the digastric, stylo-hyoid, and hyo-glossus 
muscles ; then horizontally forward to the tip of the 



ANATOMY. jjj 

under surface of the tongue under the name of the 
ranine artery. Its branches are four, viz. : — hyoid, 
dorsalis linguae, sublingual and ranine. 
Describe the occipito-frontalis. 

It arises from the superior curved lines of the oc- 
cipital bone and mastoid portion of the temporal, forms 
a fleshy belly about two inches in length ; then be- 
comes aponeurotic, passing over the vertex of the 
skull, and, terminating at the frontal bone into an an- 
terior belly of muscular fibres, its insertion is formed 
by blending with the pyramidalis nasi, orbicularis 
palpebrae, and corrugator supercilii muscles. Its 
action is to raise the eyebrows and produce transverse 
wrinkles on the forehead. 

Nerve supply : The frontal portion is supplied 
by the temporal branch of the facial ; the posterior 
portion, by the posterior auricular branch of the 
facial. 

What muscles control the eye ? 

Superior oblique, inferior oblique, internal rec- 
tus, superior rectus and inferior rectus. 

Which artery is the longest, the external or in- 
ternal carotid ? 

Internal carotid. 

Mention the bones of the cranium. 

Occipital, sphenoid, ethmoid, two temporal and 
two parietal. 

flention the muscles of the pharynx. 

Inferior constrictor, middle constrictor, superior 



334- ANATOMY. 

constrictor, stylo-pharyngeus. palato-pharyngeus, and 
salpingo-pharyngeus. 

Describe (a) the facial vein, (b) the internal max= 
illary vein. 

The facial vein commences at the side of the root 
of the nose, being a continnation of the angular 
vein. It lies posterior to the facial artery, and, fol- 
lowing a less tortuous canal, it passes downward and 
backward, and then over the body of the lower jaw. 
It lies with the facial artery ; continuing obliquely 
outward and backward, it unites with the anterior di- 
vision of the tempero-m axillary vein, forming the com- 
mon facial vein, which enters the internal jugular. 

(b) The internal maxillary vein is a vessel 
which accompanies the internal maxillary artery and 
is of considerable size. It receives the following 
veins : Middle meningeal, the deep temporal, the 
pterygoid, the masseteric, the buccal, alveolar, in- 
ferior dental and some palatine veins. The trunk of 
the vein passes backward behind the condyle of the 
inferior maxillary bone, and unites with the temporal 
vein, forming the tempero-maxillary vein. 

Give the branches of the external carotid artery. 

Superior thyroid, lingual, facial, occipital, pos- 
terior auricular, ascending pharyngeal, temporal and 
internal maxillary. 

What muscles have their origin in the styloid 

process ? 

Stylo-pharyngeus, stylohyoid, and stylo-glossus. 

Give the origin and insertion of the sterno=rnas= 
toid muscle. 



ANATOMY. 335 

It arises by a round tendon from the anterior 
part of the front of the sternum, and by a flat tendon 
from the inner superior border of the clavicle, the 
two heads converging about an inch above the origins 
to form a strong muscle which passes obliquely up- 
ward and backward to be inserted into the mastoid 
process of the temporal bone. 

Describe the tensor palati. 

It arises from the scaphoid fossa of the sphenoid 
bone and the margin of the Eustachian tube, passes 
at first downward, then becoming tendinous, reflected 
around the hamular process of the internal pterygoid 
plate, and extends horizontally to be inserted into the 
soft palate, its fibres blending with its fellow of the 
opposite side ; it is also attached to the transverse 
ridge of the horizontal portion of the palate bone. 

Nerve supply. — A branch from the pharyngeal 
plexus. Its action is to make the palate tense. 
What bones articulate with the vomer? 

Sphenoid, ethmoid, two palate and two superior 
maxillary. 

Describe the sphenoidal fissure. 

It is situated in the posterior part of the orbital 
cavit}' between the greater and lesser wings of the 
sphenoid bone. It is bounded above by the lesser 
wing, below by the greater wing, internally by the 
body, and is converted into the foramen lacerum 
arteritis by the articulation of the frontal bone. It 
transmits the third and fourth ophthalmic divisions 
of the fifth and sixth cranial nerves, some filaments 



jj6 ANATOMY. 

of the cavernous plexus of the sympathetic system, 
a branch of the orbital artery to supply the dura 
mater, the recurrent branch of the lachrymal artery, 
ophthalmic vein, and processes of the dura mater. 

Describe the glenoid fossa. 

It is situated between the anterior and middle 
roots of the zygoma of the temporal bone. It is 
bounded anteriorly by the anterior root and eminentia 
articularis ; above and externally, by the middle root 
and auditory process ; posteriorly, by the tympanic 
plate. It is divided into two parts by the Gasserian 
fissure ; the anterior part receives the condyle of the 
lower jaw, and the posterior part receives the parotid 
gland. 

riention the bones of the face. 

Two nasal, two superior maxillary, two lach- 
rymal, two malar, two inferior turbinated, two palate, 
vomer, and inferior maxillary. 

What nerve and artery passes through the fora= 
men ovale of the sphenoid bone ? 

The inferior maxillary division of the fifth nerve, 
and the small meningeal branch of the first part of 
the internal maxillary artery. 

Mention the muscles attached to the inferior max= 
illary bone. 

Fifteen pairs, viz., levator men ti, depressor labii in- 
ferioris, depressor anguli oris, platysma myoides, buc- 
cinator, masseter, orbicularis oris,genio-hyo-glossus, 
genio-hyoid, mylo-hyoid, digastric, superior constrict- 



ANATOMY. 337 

or, temporal, internal pterygoid, and external ptery- 
goid. 

Mention the principal veins of the head and neck. 

The principal veins of the head are the frontal, 
angular, facial, temporal, internal maxillary, temporo- 
maxillary, occipital ; of the neck, external jugular, 
internal jugular, anterior j ugular and vertebral. 

What muscles are attached to the basilar process 
of the occipital bone ? 

Rectus capitis anticus, major and minor, and 
superior constrictor of the pharynx. 

Give the boundary of the anterior triangle of the 
neck. 

It is bounded superiorly by the inferior border of 
the lower jaw, and a line extending from the angle of 
the mastoid process of the temporal bone. Posteriorly, 
by the anterior margin of the sterno-mastoid muscle. 
Anteriorly, by the median line of the neck. 

flention the muscles attached to the outer surface 
of the malar bone. 

Levator labii superioris, zygomaticus major and 
minor. 

Describe the sigmoid notch. 

It is situated between the condyloid process and 
coronoid process of the superior border of the inferior 
maxillary bone. It transmits the masseteric vessels 
and nerves. 

Mention the branches of the maxillary portion of 
the internal maxillary artery. 



33 8 ANATOMY. 

Tympanic, great or middle meningeal, small 
meningeal, and inferior dental. 

Mention the branches of the posterior auricular 
artery. 

Stylomastoid, anricnlar, mastoid, muscular and 
glandular. 

Give the branches of the internal maxillary artery. 

This artery is divided into three parts, namely : 
Maxillary, pterygoid and spheno-maxillary. 

C Tympanic, r Deep temporal, 

Maxillary \ Middle meningeal, Pterygoid \ Buccal, 

portion: / Sma11 meningeal, portion: ) Pterygoid, 

v Inferior dental. V. Masseteric. 

C Alveolar, 
\ Infraorbital, 
Spheno-maxillary j Descending palatine, 

portion: \ Vidian, 

.' Pterygo-palatme, 
t Spheno-palatine. 

Describe the Gasserian ganglion. 

It is found on the fifth nerve and is situated in 
the Gasserian depression on the apex of the petrous 
portion of the temporal bone, between the bone and 
dura mater. It is entirely sensory, and, as the motor 
root passes beneath it, it gives off three large branches 
or divisions, — ophthalmic, superior maxillary and 
inferior maxillary. 

Give the origin and insertion of the sternothyroid 
muscle. 

It arises from the posterior surface of the upper 

part of the sternum and cartilage of the first rib, and 

is inserted on the oblique line on the side of the ala 

of the thryoid cartilage. 



A NATO Ad Y. 339 

Describe the myIo=hyoid muscle, giving its origin 
and insertion. 

This muscle forms with its fellow the floor of the 
mouth. It arises from the whole length of the mylo- 
hyoid ridge of the inferior maxillary bone and is in- 
serted into the hyoid bone, meeting its fellow in a 
median raphe. 

Nerve, the mylo-hyoid, a branch of the inferior 
dental. 

Its action, assists in carrying the tongue upward 
and forward. 

/lention the orbital branches of the ophthalmic 
artery. 

Lachrymal, supra-orbital, posterior ethmoidal, an- 
terior ethmoidal, palpebral, frontal, nasal, muscular, 
ciliary. 

Describe the temporal fossa. 

It is situated at the side of the skull, and is 
bounded above by the temporal ridge ; in front by the 
frontal, malar, and great wing of the sphenoid ; ex- 
ternally, by the zygomatic arch. Below, it is sepa- 
rated from the zygomatic fossa by the pterygoid ridge, 
seen on the outside of the great wing of the sphenoid 
bone. This fossa is formed by parts of five bones, 
viz. : Sphenoid, frontal, parietal, temporal and malar. 
It gives origin to the temporal muscle. 

Describe the great wing of the sphenoid bone. 

It projects from the sides of the body and 
presents three surfaces, — superior, anterior and ex- 
ternal. 



340 ANATOMY. 

Superior surface : Smooth and concave, and 
helps to form the middle fossa of the cranial cavity ; 
it contains the following foramina : Rotundum, ovale, 
vesalii, spinosum. 

Anterior surface : Is quadrilateral, smooth, con- 
cave and helps to form the outer wall of the orbital 
cavity. The superior border articulates with the 
frontal, the external border articulates with the malar, 
the inferior border forms the posterior boundary of the 
spheno-maxillary fossa, and the internal border helps 
to form the sphenoidal fissure. 

External surface : Helps to form two fossae, 
temporal and zygomatic, which are separated by the 
pterygoid ridge. 



PHYSIOLOGY AND HYGIENE. 

Give the sources of saliva and its chemical func- 
tions and otherwise. 

Saliva is the secretion of the parotid, submaxil- 
lary and sublingual glands. It contains a ferment, 
ptyalin, which converts starch into maltose. The 
saliva facilitates speech by moistening the mucous 
membrane of the mouth ; and on account of its con- 
tained mucin facilitates deglutition by lubricating the 
bolus of food. By dissolving some of the solids in the 
food it allows them to be tasted. 

Where and how are the products of digestion fin- 
ally incorporated into the tissues ? 

The digested food is absorbed mainly by the villi 
of the small intestines. The water, soluble salts, 
glucose and peptones are passed through the columnar 
epithelium of the villi into the capillaries. These 
capillaries are radicals of the portal vein, and through 
this vein the products are carried to the liver. The 
blood of the liver passes out through the hepatic vein 
into the inferior vena cava and thus into the general 
circulation. The peptones during their passage 
through the columnar epithelium are converted into 
albumens and globulins. The digested fat passes 
through the columnar epithelium of the villi into the 
central lymphatic vessel or lacteal. These lacteals 



342 PHYSIOLOGY AND HYGIENE. 

carry the absorbed fats to trie thoracic duct, which in 
turn empties thein into the left sub-clavian vein, and 
thus into the general circulation. 

Describe the physiological process that takes place 
in the kidneys. 

The kidneys are compound tubular glands secret- 
ing urine. The tubules commence in the Malpighian 
corpuscles in the cortex. After leaving these the 
tubules become convoluted, then pass down as the loops 
of Henle, again become convoluted, and finally empty 
into the collecting tubules. The convoluted portions 
are lined with rodded epithelium, and it is by these 
cells that the urea ;s picked out of the blood. All the 
substances found in the urine are waste products cir- 
culating in the blood, and these the epithelium picks 
out from the blood. The one exception to this is 
hippuric acid which is formed by the kidney cells. 

Describe the stomach and its secretions. 

The stomach is the ovoid dilation of the gastro- 
intestinal tract ; and is a muscular sack lined inside 
with mucous membrane, and outside with a serous 
membrane. The food enters from the oesophagus at 
the cardiac orifice, and'passes out into the duodenum 
at the pyloric orifice. The stomach has two curva- 
tures, the upper, or lesser curvature, and the lower, 
or greater curvature. That portion of the stomach, 
lying towards the spleen and forming a part of the 
greater curvature, is called the fundus. The stomach 
has four coats : serous, or outer ; muscular, of which 
there are three distinct layers, circular, longitudinal 



PHYSIOLOGY AND HYGIENE- 3 4 3 

and oblique; submucous; and mucous, imbedded in 
which we have the tubular glands that secrete the 
gastric juice. 

The gastric juice is a limped, acid secretion, 
specific gravity 1005, containing salts, hydrochloric 
acid (.2%), and two ferments, pepsin and rennin. 
About ten pints are secreted daily. 

How is the skin kept moist and the cuticle 
pliable ? 

The skin is kept moist by the sweat, and the cut- 
icle pliable by the sebaceous secretion. 

What are the sources of heat in the body ? 

Heat is produced in the body by katabolism prin- 
cipally in the muscular and glandular tissues. 

Trace the circulation of the blood once around its 
course beginning at the right auricle. 

The blood enters the right auricle from the sup- 
erior and inferior vena cavas, thence through the right 
auriculo-ventricular or tricuspid valve into the right 
ventricle , past the pulmonary semilunar valve into the 
pulmonary artery to the capillaries of the lungs ; from 
the lungs it is carried back through the pulmonary 
veins to the lejl auric le, past the left auriculo-ventri- 
cular or mitral valve into the left ventricle, through the 
aortic semilunar valve into the aorta and its branches 
to the capillaries of systemic circulation, and from these 
it is carried back to the heart by the systemic veins. 

What is waste, and by what organs is it elimi- 
nated from the system ? 



344 PHYSIOLOGY AND HYGIENE. 

Waste is products of metabolism of no further 
use to the organism. Waste is eliminated by the 
lungs, kidneys, skin and liver. 

In what various ways is the loss by waste re- 
stored ? 

By food, water and respiration ; the blood acting 
as a medium of exchange. 

Describe the mechanical process by which the 
blood receives oxygen. 

The blood receives its oxygen in the lungs where 
the capillaries containing venous blood are separated 
from the oxygen of the air by a single layer of pave- 
ment epithelium. Three factors are concerned in the 
absorption of oxygen : mechanical law of pressure of 
gases, chemical affinity between hemoglobin and 
oxygen, and the vital activity of the epithelium of ' 
the air vesicles. 

By what special fluid is nourishment to the tissues 
delivered, and how ? 

By the circulating blood, by osmosis through the 
capillary walls. 

Describe fully the preparation of pabulum for the 
blood. 

The starches are converted by ptyalin of saliva 
and amylopsin of pancreatic juice into maltose. 

Maltose and cane sugar are converted into glu- 
cose by the invertin of succus entericus. Caseinogen 
is converted into casein by therennin of gastric juice, 
and the milk curdling ferment of pancreatic juice. 



PH YSIOL OGY AND HYGIENE. 345 

The proteids are changed into proteoses and 
peptones by the pepsin of gastric juice and the trypsin 
of pancreatic juice. 

The fats are split up into fatty acids and glycerine, 
saponified and emulsified by the steapsin of pancreatic 
juice and by the bile. 

The digested food is then absorbed by the villi of 
the small intestines. The fats are carried by lacteals 
to the thoracic duct ; and the glucose, water, soluble 
salts and peptones are carried by portal vein to the 
liver, the peptones being changed into native proteids 
while passing through the epithelium of the villi. 

What is the medulla oblongata ? Give a short 
description. 

The medulla oblongata is that portion of the cen- 
tral nervous system between the upper end of the 
spinal cord and the lower boundary of the pons 
Varolii. 

It is pyramidal in shape with the base upward, 
and is about one inch long, three fourths of an inch 
wide and half an inch thick. Anteriorly is seen the 
anterior median fissure, the olivary bodies, and the 
anterior pyramids. 

The posterior surface of the medulla forms part 
of the floor of the fourth ventricle bounded on each 
side by the diverging posterior columns of white mat- 
ter. Laterally we find emerging the cranial nerves 
from the sixth to the twelfth inclusive. 

In structure we find that it is made up of gray 
and white matter. 



34-6 PHYSIOLOGY AND HYGIENE. 

The gray mattter is cut up into small masses by 
the motor and sensory decussations. These masses 
of gray matter form the nuclei for most of the 
cranial nerves. 

Describe the mechanism of the heart. 

The heart is a hollow muscular organ divided in- 
to four cavities, two on the right side and two on the 
left. Between the two sides there is no communica- 
tion. The right side receives venous blood and forces 
it into the pulmonary circulation. The left side re- 
ceives arterial blood and forces it into the general, 
systemic or greater circulation. The two auricles, 
contracting simultaneously toward the end of ventri- 
cular diastole, force the blood into the ventricles. The 
ventricles then contract, the auriculo-ventricular 
valves are closed, and the blood is forced into the 
arteries. 

The ventricles then relax and the blood flows in 
from the auricles, the auriculo-ventricular being open. 
The blood tends also to regurgitate into the ventri- 
cles from the arteries, but is prevented by the closure 
of the semilunar valves. The heart has been likened 
to a force pump, but it is also a suction pump, for dur- 
ing diastole, there is a negative pressure in the vent- 
ricles due to the elasticity of the muscular wall tend- 
ing to produce a vacuum. 

As to the nervous mechanism of the heart, we 
find in the medulla the cardio inhibitory aud the 
cardio accelerating centres. The efferent nerve from 
the cardio-inhibitory centre to the heart is the vagus 



PHYSIOLOGY AND HYGIENE. 347 

or pneumogastric ; the efferent from the cardio-accele- 
rator centre is the accelerator branch of the sym- 
pathetic system. These nerves end in ganglionic 
masses in the heart. 

There is also an afferent nerve from the heart 
called the nervous depressor of the Cyon and Ludwig. 
When there is danger of rupture of the heart 
from over-pressure, it is irritated and carries an im- 
pulse to the vasomotor centre that depresses its tonus 
and lowers the blood pressure. 

Describe the pancreas, and the character and func= 
tions of its secretion. 

The pancreas is a tongue-shaped organ about six 
inches long, weighing about two ounces and situated 
back of the stomach. It is sometimes called the ab- 
dominal salivary gland. 

The duct enters the duodenum about an inch 
and a half below the pylorus. The bile duct joins 
with it just before it opens into the duodenum. 

The pancreatic juice is a transparent, viscid, 
alkaline fluid, specific gravity 1012. There are about 
eight ounces secreted daily. It contains salts, espe- 
cially sodium salts and four ferments. 

Amylopsin converts starch into maltose. 

Trypsin converts proteids into peptones and 
even into lower bodies, leucin, tyrosin and arginin. 

Steapsin splits up the fats into fatty acids and 
glycerine. The fatty acids combine with the alkalies 
present to form soap and this aids the emulsification 
of the rest of the fat. 

There is also a milk curdling ferment. 



3*8 PHYSIOLOGY AND HYGIENE, 

The pancreas has also an internal secretion as 
extirpation of the organ causes diabetes. 

In what way does the blood lose material ? 

By osmosis through the capillary walls into the 
tissues ; by excretion from the lungs, skin, kidneys 
and liver, and by osmosis into gastro-intestinal canal 
as in the watery stool following saline cathartics. 

Describe fully the white corpuscles of the blood, 
and give their origin. 

The white corpuscles at rest are globular nu- 
cleated masses of protoplasm about 1-2500 of an inch 
in diameter. There are a number of varieties. The 
small mononuclear or lymphocyte, the large mono- 
nuclear or transitional, the poly-morphonuclear, 
which is the most abundant, and the eosinophite 
containing coarse granules readily stained with 
eosen. 

The leucocytes have the power to throw out pseu- 
dopodia, or, it is called amoeboid movement. They 
originate in the lymphatic tissue and in the marrow 
of bones. 

What is the cerebro=spinal axis, and what is its 
function ? 

The cerebro-spinal axis is that portion of the 
nervous system consisting of spinal cord, medulla, 
pons varolii, crura cerebri, basal ganglia, cerebrum 
and cerebellum. Its function is to receive afferent 
impulses and to send out as the result of these 
efferent impulses, to keep the body in normal condi- 
tion, and through the cerebrum presides over thought, 
volition and perception. 



PHYSIOLOGY AND HYGIENE. 349 

What is the purpose of the lymphatic system and 
how fulfilled ? 

The liquid portion of the blood osmoses through 
the capillary walls into the tissue. This diluted 
blood plasma is called lymph and is carried by the 
lymphatics back to the general circulation through 
the thoracic duct. They also carry absorbed material 
as the fat from the intestines, into the general circu- 
lation. 

The secretion of some of the ductless glands is 
emptied into the blood through its lymphatics. The 
cells formed in the lymph glands become leucocytes. 

What chemical exchange is effected in the lungs 
during respiration ? 

Oxygen is obsorbed by the blood. Carbon- 
dioxide, nitrogen, water and very small quantities of 
organic volatile principles are thrown off. 

How is the normal temperature of the human 
body maintained ? 

The normal temperature of the body is main- 
tained at about 98.4 ° F., by the proper balancing of 
heat production and heat dissipation. The production 
and dissipation of heat are controlled by the thermo- 
taxic centres of the nervous system. These include 
the thermolytic, thermogenic and thermoinhibitory 
centres. 

Describe the process of deglutition and name the 
glands where secretions are an essential aid in the process. 

Deglutition is the act of swallowing or passing 
of the food from the mouth into the stomach. There 



j So PHYSIOL OGY AND HYGIENE. 

are in this act three stages, buccal, pharyngeal and 
oesophageal. The first is voluntary, the last two are 
involuntary. 

The bolus of food is forced by the tongue froni 
the mouth into the pharynx. The muscular wall of 
which contracting from above downward forces the 
bolus into the oesophagus. A peristaltic wave of con- 
traction then forces the bolus through the oesopha- 
gus into the stomach. Thus the deglutition of solids 
is a peristaltic act. But liquids are squirted through 
the pharynx and oesophagus with bulb syringe effect 
by contraction of the mylo-hyoid muscle. 

The centre of deglutition is in the medulla. It 
receives afferent impulses through the trifacial and 
glosso-pharyngeal nerves, and gives off efferent impul- 
ses through the inferior maxillary division of the trifac- 
ial and glosso-pharyngeal and vagus. 

The glands whose secretions aid deglutition are 
the salivary especially the sub-maxillary and sub- 
lingual ; also the mucous glands of the mucous mem- 
brane of the mouth, pharynx and oesophagus. 

Name the digestive secretions, mentioning the 
principal action of each upon food. 

Saliva, gastric juice, pancreatic joice, bile and 
succus entericus are the digestive secretions. 
Saliva converts starch into maltose. 

Gastric juice converts proteids into peptones, 
and caseinogen into casein. 

Pancreatic juice converts preteids into peptones, 
starch into maltose, splits up the fats into fatty acids 



PHYSIOLOGY AND HYGIENE. 



35 1 



and glycerine, and converts caseinogen into casein. 

Bile emulsifies fats and prevents excessive action 
of bacteria. 

Succus entericns converts maltose and cane sugar 
into glucose. 

Give the apparent origin and general distribution 
of the pneumogastric nerve. Mention some of the organs 
whose action it influences. 

The superficial origin of the pneumogastric is 
from the groove on the lateral surface of the medulla 
between the olivary and restiform bodies. It is dis- 
tributed to the pharynx, larynx, oesophagus, heart, 
lungs, stomach and to the abdominal sympathetic 
system. It is the motor nerve to the pharynx ; mo- 
tor and sensory to the larynx ; motor, sensory and 
respiratory to the lungs ; motor, sensory and secre- 
tory to the stomach ; cardio inhibitory to the heart, 
and secretory to the pancreas. 

Describe the liver, its secretion and the function 
thereof. 

The liver is the largest gland in the body weigh- 
ing about four pounds, and measuring transversely 
about twelve inches, antero-posteriorly about seven 
inches, and at its posterior part is about three inches 
thick. 

It is situated principally in the right hypochon- 
driac region, but extends through the epigastrium into 
the left hypochrondriac region. 

It is divided by five fissures into five lobes, the 
largest of which is the right lobe. The most impor- 



352 PHYSIOLOGY AND HYGIENE, 

tant fissure is the transverse ; for through this the 
blood enters the liver through the portal vein, and 
hepatic artery, and passes out through the hepatic vein. 
The bile also passes out through the hepatic duct 
through this fissure. 

The secretion of the liver is bile. 

Bile is a reddish yellow, or reddish green, alka- 
line, viscid, bitter liquid with a specific gravity of 
about 1020, There are about two or two and half pints 
secreted daily. 

It contains among other substances bilirubin, 
biliverdin, taurocholate and glycocholate of sodium, 
cholesterin, mucin and inorganic salts. 

The bile neutralizes the acid chyme precipitat- 
ing the pepsin, it emulsifies fats and aids in their 
absorption ; it increases peristalsis ; it is a slight an- 
tiseptic ; and contains waste products thrown off by 
the liver. 

State the average proportion of carbon=dioxide in 
iooo parts of atmosphere. What should be the maximum 
limit of carbon=dioxide in school rooms. 

Four parts of carbon-dioxide to ten thousand of 
air is the normal. 

The maximum limit of carbon-dioxide in a school 
room should be .05%. 

flention the nutritive fluids of the body. 

Blood, lymph and chyle. 

What conditions affect the body temperature ? 

All conditions affect the body temperature that 
destroy the balance between heat production and heat 
dissipation . 



PHYSIOLOGY AND HYGIENE, 353 

Among these you have muscular exercise, diges- 
tion, prolonged exposure to extremes of temperature, 
shock (mental or physical), hysteria, drugs (as anti- 
pyrin, chloral hydrate and atropine), toxins of bac- 
teria, injection of peptones and ptomaines, irritation 
of any one of the thermotaxic centres. 

Give the composition of the pancreatic secretion. 

According to Halliburton you have 97.6% of 
water; 1.8% of organic matter of which the most im- 
portant are the ferments ; and .6% inorganic salts, 
among which are sodium chloride, sodium phosphate 
and potassium chloride. 

Give the properties of pancreatic juice, and state 
its reaction. Where does the pancreatic juice enter the 
intestine. 

The pancreatic juice is a colorless, transparent, 
viscid, alkaline fluid with a specific gravity of 1012. 
It contains four ferments ; trypsin, amylopsin, steap- 
sin and a milk-curdling ferment. 

The pancreatic juice enters the intestine through 
an opening in the posterior surface of the duodenum 
about its middle. 

Give the composition of blood, and state the use 
of each component part. 

The blood is composed of sixty parts of plasma or 
liquor sanguinis, and forty parts of corpuscles. 

The plasma is the liquid portion and contains 
about ten per cent of solid matter of which four-fifths 
are proteids. The solid matter is made up of serum 
albumen, serum globulin, fibrinogen, salts, glucose, 
fats and extractives. 



354 PHYSIOLOGY AND HYGIENE. 

There are two kinds of corpuscles, red and white. 

The red corpuscles are the more numerous, the 
proportion being five hundred red to one white. The 
principal substance in the red corpuscle is the hemo- 
globin. 

The white corpuscles have amoeboid movement, 
and have a phagocytic action. By their disintegration 
fibrin ferment is formed. 

The red corpuscles carry the oxygen to the 
tissues. 

The fibrinogen clots after leaving the vessel and 
thus stops bleeding. 

The plasma carries the absorbed food to the 
tissues and the waste products to the excretory 
organs. 

The blood also keeps the various parts of the body 
at a fixed temperature. 

The function of the blood plates is not known. 

State the difference between the vasoconstrictor 
nerves and the vaso=dilator nerves. 

The vaso-coristrictors, when stimulated, decrease 
the calibre of the arterioles by causing a contraction 
of the muscular fibres in the middle coat of the 
vessels. 

The vaso-dilators, when stimulated, increase the 
calibre of the arterioles by inhibiting or decreasing 
the tonus of the local vaso-motor ganglia in the mus- 
cular wall. 

Define voluntary muscle ; involuntary muscle. 
Give example of each. 

The voluntary muscles are those under the con- 



PHYSIOLOGY AND HYGIENE, 355 

trol of the will, and are transversely striated. The 
biceps is an example of a voluntary muscle. 

The involuntary muscles are those not under 
the control of the will, and are not transversely 
striated. The muscular coat of the arteries is an 
example. 

State the function of the hypoglossal or sublingual 
nerve. 

It is the motor nerve of the tongue and the mus- 
cles connected with the hyoid bone. 

What special centers exist in the medulla ob= 
longata ? 

Deglutition, salivation, mastication, vomiting, 
diabetic, cardio-inhibitory', cardio-accelerator, vaso- 
motor and respiratorion. 

What is the function of the cerebrum ? 

The cerebrum is the center of volition, perception 
and ideation. 

What is the difference between proteid and amy- 
loid food ? 

Proteids contain carbon, hydrogen, oxygen, nitro- 
gen and sometimes phosphorus. 

The amyloid foods contain carbon, hydrogen and 
oxygen ; the last two elements in the proportion to 
form water ; and in the molecule, six atoms of carbon 
or a multiple of six. 

The body can form amyloids from proteids, but 
cannot form proteids from amyloids. 
Describe the nerve fibre. 



35 6 PHYSIOLOGY AND HYGIENE- 

A nerve fibre consists of an axis cylinder or 
nenroaxon covered with myelin or white substance of 
Schwann, which in tnrn is covered by the neurilemma 
or sheath of Schwann. Along the nerves there are 
constrictions known as the nodes of Ranvier. The 
nerves of the sympathetic system do not contain 
myelin, or are non-medullated. 

What is meant by flexion and extension of 
muscle? 

By flexion is meant the shortening or contraction 
of the muscle. 

The relaxation or lengthening of the muscle is 
called extension. 

Describe the form and give the location of the 
stomach. State the work accomplished by the stomach. 

The stomach is somewhat ovoid in form with its 
large end toward the left. It is situated in the front 
part of the upper abdomen in the epigastric region 
with its pyloric end a little below and to the right of the 
xiphoid cartilage, and its fundus projecting over into 
the left hypochondrium. 

The stomach changes the proteids into peptones, 
curdles milk, and liquefies fats. 

Describe the stomach and its movements during 
digestion. 

The stomach is an irregularly ovoid, muscular 
sack lined inside with mucous membrane, and outside 
with serous membrane. It is the dilated portion of 
gastrointestinal tract between the oesophagus and 
small intestine. The stomach holds, when full, about 
three pints. It has two openings, the cardiac, through 



PHYSIOLOGY AND HYGIENE. 35 y 

which the food enters the stomach, and the pyloric, 
through which the food leaves the stomach. It has 
two curvatures, the upper or lesser and the lower or 
greater. The portion of the greater curvature lying 
toward the spleen is called the fundus. 

When the food reaches the stomach the two ori- 
fices close tightly like sphincters ; the muscular wall 
also contracts down upon the food, and by means of 
the three muscular layers keeps the food in constant 
motion. Thus it brings fresh portions constantly to 
the surface to be acted upon by the gastric juice. A 
current passes down the fundus and greater curva- 
ture to the pylorus and back along the lesser curva- 
ture. After an hour of gastric digestion, the tightly 
closed pylorus gradually relaxes allowing some of the 
liquid chyme to enter the duodenum. Finally, at the 
end of three or four hours, even the more or less 
solid undigested portion is allowed to escape and enter 
the duodenum. 

Describe the alveolar process and state how it is 
developed. 

The alveolar process is made of an inner plate 
and an outer plate which are of compact osseous tis- 
sue. Between these plates there is a cancellous 
structureiwhich is hollowed out into compartments for 
the different teeth. 

The alveolar process is of mesoblastic origin be- 
ing formed by the osteoblasts of the periosteum. As 
the permanent teeth form, the process is somewhat 
rebuilt to accommodate them. 



358 PHYSIOLOGY AND HYGIENE. 

What is the epiglottis ? 

The epiglottis is one of the single cartilages of 
the larynx. It is fonnd at the base of the ton gne 
and on the anterior edge of the upper opening of the 
larynx. 

State the distinction between mucous membrane 
and serous membrane. 

A mucous membrane consists of a layer or lay- 
ers of epithelial cells on a basement membrane and 
secretes mucus. 

A serous membrane consists of a single layer of 
endothelial cells on a layer of fibrous tissue. 

The mucous surfaces communicate with the ex- 
ternal surface. The serous cavities are closed sacs, 
and belong to the lymphatic system. 

Give the percentage of (a) animal matter in 
enamel ; give the percentage of (b) mineral matter in 
enamel. 

(a) Animal matter 3.5%. 

(b) Mineral matter 96.5%. 

Describe (a) the arterial system, (b) the capillary 
system. 

The arteries are tubes that carry the blood from 
the heart to the capillaries. The systemic arteries 
commence in the aorta which divides and sub-divides. 
The cross-section of the aorta is much less than the 
combined cross-section of the arterioles. The arteries 
have three coats. The intima consists of a layer of 
endothelial cells on a basement membrane, and num- 
erous yellow^ elastic fibres ; the media consists princi- 



PHYSIOL OGY AND HYGIENE. 359 

pally of involuntary muscular fibres, arranged cir- 
cularly, which are controlled by the local vasomotor 
ganglia ; the adventitia consists principally of areolar 
tissue containing some elastic fibres. The yellow 
elastic fibres are comparatively more abundant in the 
large arteries; the muscular more abundant in the 
arterioles. 

The capillaries are small tubes consisting of a sin- 
gle layer of lance-shaped endothelial cells. They 
connect the smallest arteries with the smallest veins. 
They are about one-thirtieth of an inch long, and of 
sufficient calibre to allow a red corpuscle to pass 
through. 

How is bone nourished? How is dentin nourished ? 

Bone is nourished by the blood through the 
nutrient artery circulating in the marrow and Haver- 
sian Canals. It is also nourished by the perios- 
teum. 

The dentin is nourished by the dental pulp. 
State the function of epithelium. 

Epithelium secretes and protects. 

State the importance of the blood to the body. 

The blood carries the food and oxygen to the 
tissues, and carries the carbon-dioxide and other 
waste products from the tissues to the excretory 
organs. 

It is also by the circulation of the blood that the 
the temperature of the various parts of the body is 
equalized. 



j6o PHYSIO LOG Y AND HYGIENE, 

State the influence of posture on the action of the 
heart. 

There is an increase of nine to sixteen pulse 
beats when one rises from a reclining to a standing 
posture ; the volume and force of the pulse increases at 
the same time. The effect of the sitting posture is 
intermediate between the two. 

flention three inorganic substances found in the 
body. State in what part of the body each is found. 

Hydrochloric acid in the gastric juice. 
Sodium chloride in blood. 
Calcium carbonate in bone. 

How is animal heat regulated and maintained ? 

Animal heat is regulated by the thermotaxic 
centres which keep a proper balance between heat 
production and heat dissipation. 

It is maintained by katabolism, especially oxida- 
tion, in the tissues. 

What is the difference in function between the 
right and left sides of the heart ? 

The right side receives venous blood and forces 
it through the pulmonary circulation. 

The left side receives arterial blood and forces 
it through the systemic or greater circulation. 

State the hygienic precautions that should be 
taken to prevent the spread of typhoid germs. 

The drinking water should be boiled, and the 
milk also if it is suspected of possibly being in- 
fected. 

The feces and all secretions, like urine and 



PHYSIOLOGY AND HYGIENE. 3 6r 

nasal mucus should either be destroyed by fire or 
properly disinfected with a strong solution of bichlo- 
ride of mercury, chlorinated lime, formalin or car- 
bolic acid. 

The clothing of the patient and the bed linen 
should be placed in strong bichloride solution, or pre- 
ferably boiled for a half hour. 

The glasses and other dishes used by the patient 
should be boiled. 

What instruction as to hygiene and sanitation 
should be given in a case of diphtheria? 

The case should be isolated, the house quaran- 
tined, and possibly those who have been exposed (es- 
pecially children) had better be given a small dose of 
antidiphtheritic serum. 

The room should be well ventilated and as much 
sunshine as possible should be allowed to enter. 

The discharge from the mouth and nose should 
be destroyed by fire ; the dishes should be boiled. 

The clothing and bed linen should be boiled or 
destroyed by fire. 

After the case has terminated the room should be 
thoroughly disinfected with formalin or sulphurous 
acid, and the woodwork washed with i to 1,000 
bichloride of mercury solution. 

Describe the physiological action of (a) saliva, (b) 
gastric juice, (c) pancreatic juice. 

The ptyalin of saliva converts starch into mal- 
tose. 



362 PHYSIOLOGY AND HYGIENE. 

The rennen of gastric juice changes caseinogeii 
into casein, and pepsin in an acid medium converts 
proteids into peptones. 

As to pancreatic juice, trypsin in an alkaline so- 
lution converts proteids into peptones or even into 
lower bodies leucin, tyrosin and arginin. It also 
changes some of the albumoids into peptone-like 
bodies. Amylopsin com^erts starch into maltose. 
Steapsin splits up the fat into fatty acids and glycerin. 
The milk curdling ferment curdles milk. 

State the function of each of the following mus= 
cles : (a) temporal, (b) masseter, (c) occipito=frontalis, 
(d) orbicularis palpebrarum, (e) orbicularis oris. 

The temporal and masseter draw the lower jaw 
upward and are muscles of mastication. 

The occipito-frontalis moves the scalp and raises 
the eyebrows. It is a muscle of expression. 

The orbicularis palpebrarum is the sphincter mus- 
cle of the eyelid ; and is also used as a muscle of 
expression. 

The orbicularis oris is the sphincter of the mouth. 
It is a muscle of mastication, and also used in speak- 
ing and expression. 

State the normal pulse at each of the following 
ages : One year ; ten years ; fifty years. 

One \^ear it is 115 to 120. 
Ten years it is 80 to 90. 
Fifty years it is 70 to 75. 

Describe the capillaries. 

The capillaries are small tubes connecting the 
smallest arteries with the smallest veins. They con- 



PHYSIOLOGY AND HYGIENE. j6j 

sist of a single layer of lance-shaped endothelial 
cells. They are about one- thirtieth of an inch long, 
and on an average one-three-thousandth of- an inch 
in diameter. 

Why is blood light in the arteries and dark in the 
veins? 

Oxyhemoglobin found in the arteries is a lighter 
red than the deoxidized hemoglobin found in the 
veins. 

Is the natural condition of saliva alkaline or acid, 
and how is it tested ? 

It is alkaline, and is tested with litmus or phe- 
nol phthalein. 

What is the reaction of gastric juice ? 

Acid. 

What is the normal temperature of the surface of 
the body ? 

Very variable. The axillary temperature is 
about 98 degrees Fahr. 

Name some of the impurities found in rain water 
that is stored in cisterns. 

Unicellular organisms of many kinds, decaying 
vegetation, nitrites, ammonia, nitric acid, and mechan- 
ical impurities. 

What is bile ? What are its functions, and by 
what organ is it secreted ? 

Bile is the viscid bitter, greenish-brown or yellow, 
alkaline secretion of the liver, having a specific grav- 
ity of about 1020. There are about two pints secret- 
ed daily. 



364 PHYSIO LOG Y AND HYGIENE. 

Bile neutralizes the acid chyme, precipitates the 
pepsin ; it emulsifies fats and aids in their absorption ; 
it increases peristalsis, and is an antiseptic ; it also 
contains waste products thrown off by the liver. 

Define assimilation. 

Assimilation means the conversion into proto- 
plasm of the nutrient material or food ingested. 

State the use and importance of (a) perspiration, 
(b) bathing. 

By the evaporation of perspiration the body is 
kept at a fixed temperature. The perspiration carries 
off waste products ; keeps the skin pliable, and when 
need exists relieves the kidneys of stress of work. 

Bathing cleanses the external surface, stimulates 
the function of the skin, and increases the general 
tone of the body. 

Define tissue. 

A tissue is a collection of intercellular substance 
and cells having the same anatomic and physiologic 
characteristics. 

State the object of respiration. 

By the act of respiration oxygen is taken into 
the blood, and carbon-dioxide, small quantities of ni- 
trogen, water and some organic volatile substances are 
thrown off from the body. 

In some animals the evaporation of water, and 
thus dissipation of heat by frequent respirations, is 
quite marked. 

Describe the movements of the heart. 



PHYSIOLOGY AND HYGIENE j6j 

The two auricles contracting force the blood 
through the auriculo-ventricular orifices into their cor- 
responding ventricles. These in turn contracting, 
force the blood past the semilunar valves into the 
pulmonary artery and aorta. The blood is prevented 
from regurgitating into the auricles during systole by 
the closure of the auriculo-ventricular valves. The 
ventricles then relax to be refilled with blood from 
the auricles. At the same time the semilunar valves 
are closed by the blood attempting to regurgitate from 
the arteries. 

During ventricular systole the heart becomes 
shorter and more globular, the base being forced down 
by the recoil from the forcing of the blood into the 
aorta. The heart rotates a little during systole. 

Give the mechanical uses of saliva. 

Saliva assists in deglutition, in mastication, in 
speaking and in taste. 

In what way does absorption of food occur ? 

Most of the food is absorbed by the villi in the 
small intestines. 

Two factors are concerned in absorption, — osmo- 
sis and vital activity of the columnar epithelium of 
the villi. 

The soluble salts, glucose, water and peptones 
are carried by the capillaries through the portal vein 
to the liver and from here into the general circulation. 

The fat is carried by the lacteals to the thoracic 
duct, and through it into the left subclavian vein. 
What is the function of the liver ? 



366 PHYSIOLOGY AND HYGIENE. 

The liver secretes bile ; it forms glycogen, urea r 
uric acid and conjugate sulphate. Some of the red 
corpuscles are formed and others destroyed in the 
liver. The liver also destroys some poisons in the 
circulating blood. 

What are the functions of the muscles ? 

The muscles move the various parts of the body, 
and produce most of the heat necessary to keep the 
body at the normal temperature. 

Give the symptoms of insufficient oxygen in the 
blood. 

Dyspnoea, cyanosis, increase of blood pressure, 
and finally exhaustion with decrease of blood pressure, 
weak, flabby pulse, irregular, shallow breathing, con- 
vulsions and death. 

Describe the sympathetic nervous system, and 
state its functions. 

The sympathetic nervous system consists of a 
double chain of ganglia extending from the base of the 
skull to the coccyx along the anterior surface of the 
vertebral column. These ganglia are connected by 
intervening nerves. Besides this double chain of 
ganglia there are three large plexuses of fibres and 
ganglia (cardiac, solar and hypogastric) and numerous 
smaller plexuses. Proceding from the plexuses are 
numerous nonmedullated nerve fibres. 

The sympathetic system controls the movement 
of the abdominal viscera, and contains the vasomotor 
nerves and the cardioaccelerator. 

How should school seats be arranged with refer= 
ence to the windows ? 



PHYSIOLOGY AND HYGIENE* 3 6? 

The windows should be in back and to the left 
of the scholars ; on no account should they be placed 
in front. 

Describe the physiologic action of alcohol. 

Alcohol in small doses is a stimulant to the cere- 
brum, respiration, heart, and gastric mucous mem- 
brane. In large doses it is a depressant to cerebrum , 
respiration, heart, vasomotor system and gastric mu- 
cous membrane. It interferes with nutrition and 
causes a fall in temperature. 

Flention the valves of the heart and give their 
location. 

The mitral valve is located at the left auriculo- 
ventricular orifice. 

The tricuspid valve is located at the right auri- 
culo-ventricular orifice. 

The aortic semilunar valve is located between 
the left ventricle and aorta. 

The pulmonary semilunar valve is located be- 
tween the right ventricle and pulmonary artery. 

What is the composition of bone ? 

Bone is composed of 33% organic matter, chiefly 
collagen, and 67% inorganic matter, chiefly calcium 
phosphate and smaller quantities of calcium carbonate, 
calcium fluoride and magnesium phosphate. 

Name five of the principal elements of the body. 
Carbon, hydrogen, oxygen, nitrogen and sulphur. 
Define function. 

Function is the normal activity of an organ or 
group of organs. 



j 68 PHYSIOLOGY AND HYGIENE. 

State (a) the normal temperature of an adult ; 
the normal pulse of an adult. 

Normal temperature is 98.4 degrees Fahr. 
Normal male adult pulse is 72 per minute. 

State why blood does not coagulate within the 
blood vessels. 

The blood does not coagulate on account of its 
contact with the endothelium of the intima. 

Describe the origin and fate of the red corpuscles. 

In embryonic life the red corpuscles are first 
formed in the island Pander, later by the liver and 
spleen. After birth the red corpuscles are formed in 
the liver and spleen and the red marrow of bones, 
especially of the ribs. 

They are probably destroyed in the liver and 
spleen. 

How does the blood coagulate ? 

Fibrinogen, a proteid dissolved in the plasma, 
when acted upon by fibrin ferment in the presence of 
calcium salts is changed into fibrin.. The clot con- 
sists of this insoluble fibrin in the meshes of which 
are the corpuscles. The fibrin ferment is formed by 
the disintegration of the white corpuscles. 

Where and how is the blood changed from arterial 
to venous, from venous to arterial ? 

By the process of osmosis, the oxygen passes out 
through the capillary walls into the tissues and car- 
bon-dioxide passes into the capillaries ; thus it is 
changed from arterial to venous in the capillaries of 
the tissues. 



PHYSIOL OGY AND H YGIENE. 369 

The venous blood is forced by the right ventricle 
into the pulmonary capillaries where the blood is sep- 
arated from the atmospheric air by only the capillary 
wall and the squamous epithelium of the air cells. 

There are three factors concerned in the ex- 
change of the respiratory gases or changing the venous 
blood into arterial blood. The first is the physiologi- 
cal law of pressure of gases ; the second chemical af- 
fiinity between hemoglobin and oxygen; and third, 
the selective vital activity of the epithelial cells of the 
air vesicles. 

Describe the red and white corpuscles, giving the 
characteristics of each. 

The red blood corpuscles are yellowish, bicon- 
cave, circular, non-nucleated, elastic discs about 
1-3200 of an inch in diameter. After leaving the ves- 
sel they have a tendency to form in rouleaux or pile 
of coins. 

The red corpuscles are composed of a stroma in 
which is imbedded the hemoglobin, the oxygen car- 
rier of the blood. 

The white corpuscles when at rest are globular, 
granular, nucleated masses of protoplasm about 
1-2500 of an inch in diameter and capable of amoe- 
boid movement. Some of them pass through the ca- 
pillary walls into the tissues and eat up bacteria ; 
these are called phagocytes. 

There are four principal varieties of leucocytes ; 
the lymphocyte, the large mononuclear transitional 
leucocyte, the polymorphonuclear leucocyte, and the 



370 PHYSIOLOGY AND HYGIENE. 

eosenophile which contains coarse guanules readily 
stained with eosin. 

State the effects of starvation on the human 
body. 

The bodily weight gradually decreases and the 
temperature becomes subnormal. The fats are used 
up first, followed finally by the proteids, especially of 
the muscles. The amount of urea excreted is first, 
decreased ; but as the increased oxidation of proteids 
begins, the urea is increased. Finally death ensues 
from exhaustion. 

The heart and central nervous system lose but 
little in weight. 

Give the physiological properties and the chemi= 
cal composition of gastric juice. 

Gastric juice is a limpid acid liquid with a spe- 
cific gravity of about 1005. 

It is composed, of about 99.5% water and .5% 
solid. The bulk of which is made up of pepsin, 
rennin, and hydrochloric acid. Of the hydrochloric 
acid there are about two parts to the thousand. 

State the effects of battery currents on the normal 
human nerves. 

The faradic current stimulates them. 

A nerve during the passage of a constant cur- 
rent through it is said to be in a state of electrotonus. 
There is an increase of excitability at the negative 
pole or kathode, and decrease of excitability at the 
positive or anode. 

Differentiate between voluntary muscles and in= 
voluntary muscles. 



PHYSIOLOGY AND HYGIENE. 37 r 

Voluntary muscles are transversely striated, and 
are under the control of the will. 

Involuntary muscles are non-striated, not under 
the control of the will, and are much slower in 
action. 

How is the process of nutrition carried on ? 

The blood receives the digested and absorbed 
food and also the oxygen from the lungs. It carries 
these products to the tissues which take out what 
they need. The blood the receives the waste and 
carries it to the various excretory organs. The lym- 
phatics also carry some of the waste from the tissues 
and empty it into the venous blood. 

How does lime or other inorganic matter find its 
way into the blood ? 

Lime and other inorganic matter enter the body 
in the food and drinking water, and, being absorbed 
by the villi of the small intestines are carried by the 
portal vein to the liver and then into the general cir- 
culation. 

Describe the structure and give the functions of 
the veins. 

Tfae veins have three coats : The inner, com- 
posed of a layer of endothelial cells and elastic fibers; 
the middle, composed principally of involuntary 
muscular fibers, and the outer, composed of areolar 
tissue with numerous yellow elastic fibers. 

Many of the veins, especially of the extremities 
contain valves which help the movement of the blood 
in the veins. 



372 PHYSIOLOGY AND HYGIENE. 

The veins carry the blood from the capillaries to 
the heart. They all contain venous blood except the 
pulmonary veins which contain arterial blood. 

State the functions of the nerves. 

The nerves conduct afferent impulses to the cen- 
tral nervous system and efferent impulses from the 
central nervous system. 

What are the general effects of breathing im= 
pure air? 

You get the symptoms of intoxication from the 
impurities of the air, such as headache, general ma- 
laise, loss of appetite, interference with mental 
activity, also interference with muscular activity, 
weak, low tension pulse.* 

State the characteristics of the parotid and sub= 
maxillary glands. 

The parotid secretion is thin, watery, poor in 
solids (.3% to .5%) contains no mucin, and has excel- 
lent penetrating powers. 

The submaxillary secretion on account of con- 
taining a quantity mucin is ropy, contains 2% to 2.5% 
solids, is of a greater specific gravity, and is excellent 
for aiding deglutition. The mixed saliva has a spe- 
cifiic gravity of about 1005, is alkaline, and contains 
especially ptyalin, potassium sulphoc3^ariide, mucin, 
sodium chloride and other salts. 

Of what two great groups of substances is the 
body composed ? 

Organic and inorganic. 

Mention the organs that compose the respiratory 
apparatus. 



PHYSIOLOGY AND HYGIENE. 373 

The respiratory apparatus consists of the nose, 
pharynx, larynx, trachea, bronchi and air vesicles ; 
also of muscles moving the thorax, the diaphragm, 
the nerves (afferent and efferent) and the respiratory 
center in the medulla. 

What are the three kinds of digestion ? 

The three kinds of digestion are that of proteids, 
of carbo-hydrates and of fats. 

What are the direct sources of the heat of the 
body ? 

The most of the heat of the body is produced by 
katobolic changes, especially oxidation, taking place 
in the muscular and glandular tissues. 

Describe the parotid gland and give its function. 
Give location of the parotid gland. 

The parotid gland, the largest of the salivary 
glands, lies below and in front of the ear. The gland 
empties its secretion by Stenson's duct into the mouth 
through an opening in the mucous membrane oppos- 
ite the second upper molal tooth. It is a compound 
racemose gland composed of acini lined with polyhedral 
cells resting on abasement membrane. Under this 
is a close network of capillaries. The parotid secretes 
saliva. 

State the uses of perspiration. 

Perspiration is one of the excretions containing 
waste products and somewhat supplements the work 
of the kidney. By evaporation of perspiration the 
excess of heat produced in the body is dissipated. 
The perspiration keeps the skin moist. 



374 PHYSIOLOGY AND HYGIENE. 

State the functions of dental pulp. 

The dental pulp nourishes the dentine. The 
odontoblasts which it contains form the dentine. The 
pulp contains nerves which give sensation to the tooth 
and thus protects it indirectly. 

How many pairs of cranial nerves are there ? 
What nerves supply the teeth ? 

There are twelve pairs of cranial nerves. 
The teeth are supplied by the superior and infer- 
ior maxillary divisions of the tri-facial nerve. 

On what particular phenomena does the study of 
Physiology depend ? 

Physiology is the study of the phenomena of living 
organisms. 

To what class of tissues do the teeth belong? 

The teeth belong to osseous tissue, and are formed 
from the mesoblast with the exception of the enamel 
which is formed from the epiblast. 

At what period of life is the development of teeth 
first indicated ? 

About the fortieth day of foetal life. 
Define calcification. 

By calcification we mean the deposition of calcium 
salts in a structure. 

How does alcohol affect digestion ? 

In small doses by its irritant action on the muc- 
ous membrane it causes an increase in secretion of 
gastric juice. 

Large doses retard digestion especially that of the 
stomach. 



PHYSIOLOG Y AND HYGIENE. 375 

Define plethora anemia. 

In plethora there is an increase in the number of 
red corpuscles. 

In anemia there is a decrease of red corpuscles. 
In what organs is the blood changed ? 

It is changed in all the organs except the heart, 
but especially in the liver, kidneys, lungs, spleen, 
bone marrow and skin. 

What per cent of the weight of the body is water ? 
State the function of water in the body, and how it is 
eliminated from the body. 

About 75% of the body weight is water. 

In all the fluids of the body, water acts as a gen- 
eral solvent, beiug necessary to secretion and the 
carrying of nutrition to and the waste products from 
the tissues. By its evaporation it dissipates large 
quantities of animal heat. 

It is eliminated from the body by the kidneys, 
sweat glands, lungs and in feces. 

Describe the structure of the teeth. 

The tooth is made up of a central pulp cavity 
containing connective tissue, blood vessels, nerves, 
and around these a layer of odontoblasts which form 
the dentine and send protoplasmic prolongations into 
the dentine tubules. Around the pulp cavity is this 
covering of dentine which in chemical composition 
resembles bone but contains a little more inorganic 
material. Below the neck of the tooth the dentine is 
surrounded with the crusta petrosa which is formed 
by the osteoblasts of the dental periosteum. 



$76 PHYSIOLOGY AND HYGIENE. 

Microscopically it resembles bone with the ab- 
sence of the Haversian canals. Above the neck of 
the tooth, the dentine is covered with enamel which is 
formed by the ameloblasts derived from the epi- 
thelium of the mouth. 

The enamel consists of hexagonal columns set on 
end radiating from the center of the tooth. The en- 
amel contains very little organic matter, about 3.5%. 

What set of muscles gives the horizontal motion 
to the inferior maxillary ? 

Internal and external pterygoids. 

Define afferent and efferent nerves. 

Afferent nerves carry impulses from the peri- 
phery to the central nervous system. 

Efferent nerves carry impulses from the central 
nervous system to the periphery. 

Name three kinds of food from which starch is de- 
rived, and give the percentage of starch in each. 

Potatoes 23.7%. 
Wheat 70%. 
Rice 84.5%. 

What is the function of the gustatory nerve ? 

The gustatory nerve is the nerve of taste. 
What is casein, and where is it found ? 

Casein is a coagulated proteid found in curdled 
milk and cheese. 

How are bone and dentine formed ? 

Bone is formed by the osteoblasts of the peri- 
osteum. 



PHYSIOLOGY AND HYGIENE, 377 

: Dentin is formed by the odontoblasts. The ex- 
ternal layers of cells of the pulp cavity. 

What is the function of the dental periosteum ? 

The dental periosteum forms and afterwards 
nourishes the crusta petrosa, and holds the tooth in 
the alveolar process. 

How does the blood circulate through the heart ? 

The blood passes from the superior and inferior 
vena cava into the right auricle, which contracting, 
forces it through the tricuspid valve into the right 
ventricle. The right ventricle then contracts and 
forces the blood past the pulmonary semilunar valve 
into the pulmonary artery. This artery carries the 
blood to the lungs, and from these it is carried back 
through the pulmonary veins into the left auricle. 
Then it passes through the mitral valve into the left 
ventricle, which, contracting, forces the blood into the 
aorta. 

What is the function of the nervous system ? 

The function of the nervous system is to carry 
afferent impulses from the periphery and as a result 
of such impression to send out efferent impulses, to 
receive impressions, to preside over thought, and to 
control the action of the various parts of the body. 

Give the functions of connective tissue. 

The connective tissue binds, protects, supports 
and connects the softer and more vital tissues. 

Give the size and function of the red corpuscles. 

The red corpuscles are 1-3200 of an inch in 
diameter and 1-12000 of an inch in thickness. They 



j?8 PHYSIOLOGY AND HYGIENE. 

carry the oxygen to the tissues from the lungs and 
possibly a little carbon-dioxide back to the lungs from 
the tissue. 

How may coagulation be hastened ? 

It may be hastened by increasing the tempera- 
ture, injury to the vessel walls, contact with foreign 
matter and oxygen, agitation and addition of calcium 
salts. 

State how many of the seventy known elements 
form a practical part in making up the animal tissue, and 
mention the four most important of these elements. 

There are sixteen to nineteen elements found in 
the tissues of the body. Of these the most import- 
ant are carbon, oxygen, hydrogen and nitrogen. 

Name the four groups of tissues of which the 
organs of an adult are composed. 

Epithelium, connective, nervous and muscular. 

What is food ? State why milk is so nearly a 
perfect food. 

Food is that which taken into the body nourishes 
the tissues or supplies heat. 

Milk is so nearly a perfect food because it con- 
tains all the chemical compounds necessary to life, that 
is, proteids, carbohydrates, fats, salts and water. 
What are proximate principles ? 

Proximate principles are substances that enter in- 
to the composition of the body. 

Name three of the most important inorganic prox= 
imate principles, and state where they are found in the 
body. 



PHYSIOLOGY AND HYGIENE. 3 y 9 

Calcium phosphate is found in bone. 
Sodium chloride is found in the blood. 
Water is found all through the body. 

Are inorganic ingredients of food necessary to sus= 
tain life ? Why ? 

They are necessary because they are indispensa- 
ble constituents of the structure of the body, — as cal- 
cium salts in bone ; because the alkaline bases are 
necessary to neutralize the acids formed by the pro- 
teid metabolism ; because they are necessary for di- 
gestion and absorption, and because water is the gen- 
eral solvent of the body. 

Describe the lymphatic system and give its func= 
tion. 

The lymphatic system consists of numerous thin 
walled vessels lined with endothelium, of lymphatic 
glands situated on these vessels, of the thoracic duct, 
of the lymphatics of the intestines called lacteals, and 
the spleen. 

The thoracic duct begins in a dilated extremity 
called the cisterna magna about the level of the second 
lumbar vertebra, and runs up along the vertebral col- 
umn emptying into the left subclavian vein. It re- 
ceives the lymph from the lower extremities, abdomen, 
left lung, left arm and left face. The lymph of the 
right lung, right arm and right face is emptied through 
a small vessel into the right subclavian vein. 

The lymphatic glands are found along the course 
of the lymphatic vessels,and are composed of lymphoid 
tissue in the center of which are cells rapidly under- 
going karyokinesis. The lacteals are the lymphatic 



j8o PHYSIOL OGY AND HYGIENE. 

vessels of the intestines and carry the absorbed fats 
from the villi to the thoracic duct. 

The lymphatic S3^stem carries back into the 
blood circulation the blood plasma that has osmosed 
through the capillary walls into the tissues. It also 
forms leucocytes and carries the absorbed fat from the 
intestines into the general circulation. The secretion 
of some of the ductless glands passes through the lym- 
phatics into the blood channels. 

Describe the circulatory apparatus. 

The circulatory apparatus consists of the heart, 
arteries, capillaries and veins. 

The heart is a hollow,muscular organ, lined inside 
with the endocardium and outside with the pericardi- 
um. It is pyramidal in shape about 5^ inches long, 
3^/2 inches wide and weighs about ten ounces. It is 
divided into four cavities, two auricles and two ven- 
tricles. The ventricles are the most^important cavities, 
the left ventricle being three times as thick as the 
right ventricle. 

The ' arteries are the vessels that carry the blood 
from the heart to the capillaries. They all contain 
arterial blood with the exception of the pulmonary 
artery. Histologically they consist of three coats. 
The intima or internal coat is composed of yellow 
elastic fibers lined internally with a layer of endothe- 
lium ; the media or middle coat is made up mostly of 
involuntary muscular fibers running transversely to 
the long axis of the artery ; the adventitia or external 
coat is composed of areolar tissue containing numerous 
yellow elastic fibers. The vaso-motor nerves end in 



PHYSIOL OGY AND HYGIENE. 3 8i 

the ganglia in the muscular coat. The elastic fibers 
are found comparatively more numerous in the larger 
arteries, and the muscular fibers in the arterioles. 

The capillaries are the small blood vessels con- 
necting the smallest arteries with the smallest veins, 
and consist of a single layer of lance shaped endothe- 
lial cells. The capillaries on an average are 3 o of an 
inch long and 1-3000 of an inch in diameter. 

The veins are similar in structure to the arteries 
but the coats are not so thick. Some of the veins, 
especially those of the extremities have valves which 
prevent the regurgitation of bloodj during muscular 
contraction. 

What is the function of the red blood corpuscle ? 
Has it a nucleus ? 

The red corpuscles are not nucleated. They 
carry oxygen from the lungs to the tissues and possib- 
ly a little carbon-dioxide back to the lungs 
What is pepsin ? Where is it found ? 

Pepsin is a ferment that in an acid medium 
changes proteids into peptones. It is found in the 
gastric juice. 

What disposition is made of gastric juice after 
serving its purpose in aiding digestion ? 

The hydrochloric acid is neutralized by the al- 
kaline bile and the pepsin is precipitated. 
Define endosmosis, exosmosis. 

Endosmosis is the passage of a liquid through a 
porous diaphragm from without inward. 

Exosmosis is the passage of a liquid through a 
porous diaphragm from within outward. 



SPECIAL DENTAL ANATOMY 
AND PHYSIOLOGY. 

Give the most prominent differences between the 
form of the upper and lower bicuspids and some of the 
reasons therefor. 

The inferior bicuspids are somewhat smaller in 
every respect ; the crowns are much more rounded, 
cusps not so strongly developed ; buccal and lingual 
cusps are unlike superior bicuspids, being connected by 
a transverse ridge ; the roots are more flattened from 
mesial to distal and seldom, if ever, bifurcated. The 
upper bicuspids show a greater tendency to bifurca- 
tion. 

Name the muscles which effect the various move= 
ments of the lower jaw. 

Temporal, masseter, internal and external ptery- 
goid, genio-hyoid, mylo-hyoid, platysma-myoides,and 
the digastric. 

How is secondary dentine formed ? 

By the odontoblasts, being stimulated into ac- 
tivity by irritation of the pulp. It is most frequently 
caused by the advance of caries. 

How is cellular activity stimulated in the resorp= 
lion of the roots of deciduous teeth ? 

By the vascular papilla and probably by the 
pressure caused by the advance of the permanent 
teeth. 



ANA TOMY AND PHYSIOLOG Y 3 8j 

Give the foramen of exit, principal branches 
of distribution and function of the hypoglossal nerve. 

Anterior condyloid foramen ; branches of distri- 
bution are : Meningeal descendens hypoglossi, thyro- 
hyoid and muscular. It is the motor nerve of the 
tongue. 

Give the functions of that part of the facial nerve 
which is distributed to the oral cavity. 

Influences the sense of taste, deglutition, move- 
ments of the uvula, and soft palate and the secretion 
of the submaxillary and parotid glands. 

How, and from what source does a tooth receive 
its blood supply ? 

By means of the pulp and pericemental mem- 
brane ; from the inferior dental to the inferior teeth, 
and from the alveolar and infra-orbital to the upper 
teeth. 

What is the function of the fifth pair of nerves ? 

Gives sensibility to all parts of the face to which 
it is distributed, is the motor nerve of the muscles of 
mastication, and through fibers from the sympathetic 
governs the nutrition of the special senses. 

What anatomical structures are engaged when 
the food passes from the mouth to the stomach ? 

The tongue, soft palate, constrictors of the 
pharynx, uvula, pharynx and esophagus. 

What noticeable change would appear if the sev- 
enth nerve were excised ? 

* 

Complete loss of motion of the muscles of expres- 
sion of the face. 



384 ANATOMY AND PHYSIOLOGY. 

Mention the difference between parotid and sub= 
lingual saliva. 

The parotid saliva is thin and watery, while the 
sublingual is thick and viscid, as it contains much 
mucin. More ptyalin is found 'in parotid saliva than 
in sublingual saliva. 

Describe the natural means by which the de= 
ciduous teeth are shed. 

The resorption begins at the apical extremities 
of the root and gradually progresses towards the 
crown. It is brought about by the agency of the 
osteoclasts ; resorption taking place in the order of 
eruption contained in vascular papillae. 

What muscles are most active in opening the 
mouth ? 

Digastric, genio-hyoid, mylo-hyoid and platysma- 
myoides. 

Give in the regular order the normal average age 
at which the deciduous teeth are erupted. 

C. I. 5th to 7th month 

L. I. 9th " nth 

1st M. 1 2th " 14th 

Cuspids, 14th " 1 8th 

2nd M. 1 8th " 25th 

Describe how salivary calculus is deposited. 
Where most abundant and why ? 

Deposited upon the surfaces of the teeth from 
the saliva ; most abundant at the necks of the inferior 
anterior teeth because there is less friction, and the 
submaxillary and sublingual glands open near them. 



a 



ANATOMY AND THYSIOLOGY. jXj 

Name the muscles concerned in the act of de= 
glutition. 

Extrinsic and intrinsic muscles of the tongue, 
tensor palati, azygos uvuli, palato-pharyngeus, su- 
perior constrictor of pharynx, middle and inferior 
constrictor of pharynx, also the muscular coat of the 
esophagus. 

What are the fluids of the mouth ? Give their 
active principle and function ? 

Saliva from the salivary glands, and mucus from 
the mucous glands. The active principle of saliva 
is ptyalin, that of mucus is mucin. The function of 
saliva is to soften and moisten the food and to con- 
vert starch into maltose. The function of the mucus 
is to keep the mucous membrane of the mouth 
moist. 

Give the period of eruption of the permanent 
teeth. 

1st M. 6th to 7th year. 

C. I. 7th " 9th " 

L. I. 8th " 10th " 

1st B. C. 10th " nth " 

2nd B. C. nth " 12th " 

Cuspids, 1 2th " 13th " 

2nd M. 1 2th " 13th " 

3rd M. 1 6th " 25th " 

What is the function of the peridental membrane 
and how dees it receive its blood supply ? 

The function of the peridental membrane is to 
hold tooth in socket, give sense of touch to tooth, 
act as cushion to receive shock due to mastication, 



386 ANATOMY AND PHYSIOLOGY. 

to nourish tooth when pulp is devitalized, and to 
nourish cementuni of tooth. It receives its blood 
supply from the same arterial branch as the tooth, 
this branch giving off several twigs before entering 
the apical foramen. 

Describe the changes which occur in the tis= 
sues in the movement of the teeth in orthodontia. 

There is first a compression of the peridental 
membrane and pressure on the alveolar wall in the 
direction of the applied force, and a distention of the 
peridental membrane in the opposite direction, the 
hard structure in front is then acted upon by the 
osteoclasts and the bone behind is built up by the 
osteoblasts. When a tooth is rotated in its socket, 
the fibers of the peridental membrane are stretched. 

Describe the third division of the fifth nerve, and 
tell how it differs from the second division. 

The larger or sensory root of this compound 
nerve arises from the inferior angle of the Gasserian 
ganglion and passes downward through the foramen 
ovale in the sphenoid bone, when the motor branch 
unites with it forming one nerve. It then descends 
vertically and divides into the anterior, middle and 
posterior branches. The anterior branches divide in- 
to the buccal, deep temporal, masseteric, and ptery- 
goid branches ; the middle divides into the lingual, 
and inferior dental ; the posterior branch divides into 
the auriculo-temporal branches. 

It differs from the second division in having a 
motor root. 



ANA TOMY AND PHYSIOLOG Y. 387 

Describe the second division of the fifth nerve. 

The second division of the fifth nerve is a sensory 
nerve. It commences at the middle of the Gasserian 
ganglion and passes forward through the foramen 
rotundum, before going through this foramen it gives 
off a recurrent meningeal branch. It then crosses the 
spheno-maxillary fossa, enters the orbit through the 
spheno-maxillary fissure, traverses the infra-orbital 
canal, and appears upon the face at the infra-orbital 
foramen. In the spheno-maxillary fossa it gives off 
the spheno-palatine, temporo-malar and posterior 
superior dental. In the infra-orbital canal it gives off 
the anterior and posterior superior dental, on the face 
it gives off the labial, nasal and palpebral branches. 

Describe the physiological action of the saliva in 
digestion. 

The action of the saliva in the process of digest- 
ion is to soften and moisten the food and convert 
starch into maltose, by the agency of the organic fer- 
ment, ptyalin. 

Describe the process of absorption of the roots of 
the teeth and trace the absorbed material to its terminal. 

The absorption of the roots begins at the apical 
end and gradually progresses towards the crown. 
Commencing about the 4th year in the central incisor, 
decalcification takes place in the teeth in the order of 
their eruption. 

This phenomenon is due to the action of the ce- 
mentoclasts and odontoclasts. The decalcified mater- 
ial is absorbed by the vascular papilla, transferred by 



j88 ANATOMY AND PHYSIOLOGY. 

this means into the general circulation, carried to the 
various excretory organs and eliminated from the 
body. 

Describe the dental tubuli. 

The dental tubuli are small wave-like canals 
which run from the periphery of the pulp in a perpen- 
dicular direction to the surface. They vary in size 
from i.i to 2.3 microns. They anastomose freely. 

Describe the process of the development of the 
inferior maxilla, from which layer, and what tissue. 

Development takes place from six centres for 
each lateral half, the nuclei being deposited as early 
as the sixth or eighth week. The mandibular plates 
which are thrown off from the sides of the cranial base 
unite at the median line, after this period Meckel's car- 
tilage is developed in the substance of the mandibular 
plates and it is about this band that ossification takes 
place. The inferior maxilla is derived from connec- 
tive tissue of the mesoblastic layer of the blasto- 
derm. 

What differences are there between the roots of 
the deciduous and permanent molars, and some of the 
reasons ? 

The roots of the deciduous molars are the same 
in number as the roots of the permanent molars, but 
they are more widely separated at their apical ex- 
tremities and are smaller than the roots of the per- 
manent molars. 

At what age are the roots of the six anterior 
teeth fully developed ? 



ANA TO MY AND PHYSIOL OGY. 3 8 9 

The permanent incisors are developed at the age 
of eleven years, the cuspids at thirteen years. The 
deciduous C. I. at eighteen months after birth and 
L. I. at sixteen months, and the cuspid two years after 
birth. 

In what abnormal condition will resorption of the 
roots of temporary teeth cease ? 

When the pulp of the deciduous tooth dies. 
Describe an odontoblast and give its function. 

They are large elongated, multipolar, nucleated 
cells. Before dentiniiication they are spheroid. Dur- 
ing this process their extremities become somewhat 
flattened and square, and in the old they again assume 
their spherical form. The function is to build up 
the dentine. 

What tissue is developed from the outer layer of 
cells, and what of the inner layer of the follicular sac? 

From the outer the peridental membrane is de- 
veloped and from the inner la}^er the cementum is 
developed. 

From what sources do the different structures of 
a tooth receive their nourishment? 

The enameljfrom the dentine. Dentine, through 
the pulp. Pulp, from its vascular supply. Cement- 
um, from the peridental membrane. 

What great muscle lifts the lower jaw ? De= 
scribe its origin and insertion, and to what order of 
levers does it convert the lower jaw? 

The temporal muscle. It arises from the temporal 
fossa and fascia, and is inserted into the coronoid pro- 



39 o ANA TOMY AND PHYSIOLOG Y. 

cess of the inferior maxillary at its inner surface, apex 
and anterior border. It converts the lower jaw into a 
lever of the second order. 

In how many and what bones are the teeth 
located ? 

The teeth are located in three bones, two superior 
maxillary bones and the inferior maxilla. 

Describe the manner of their attachment. 

They are placed in the alveolar sockets of the up- 
per and lower jaw, and held in place by the transverse 
fibres of the peridental membrane and the dental lig- 
aments ; the articulation being known as a gomphosis. 

Give the forms and location of the several classes 
of the human teeth and the functional reasons therefor. 

The human teeth are divided into two classes, the 
simple and complex. In the simple class, the modi- 
fied cone is the predominating form, the free extrem- 
ity of the crown forming the base of the cone ; this 
class of teeth is found in the anterior part of the sup- 
erior and inferior maxillary bones and are so formed in 
order to best perform their function of grasping, in- 
cising and tearing. The complex teeth are composed 
externally of a number of cones all uniting at a com- 
mon base, — the neck. The roots are formed of sim- 
ple cones while the crowns are formed of smaller modi- 
fied cones; these teeth are placed posterior to the simple 
class, and are so formed and placed in order to best 
perform their function of grinding and crushing. 
Describe the maxillary sinus. 

The maxillary sinus is a pyramidal shaped 



ANATOMY AND PHYSIOLOGY. 39 i 

cavity, situated within the superior maxillary bone, 
its apex is directed outward and is formed by the 
malar process, the base by the outer wall of the nose, 
the roof by the orbital plate and the floor by the alveo- 
lar process. The walls of the sinus are very thin and 
lined with mucous membrane. The sinus communi- 
cates with the middle meatus of the nose. 
Describe the aveolus. 

An alveolus or tooth socket is formed by the 
outer and inner plate of the alveolar process. The 
shape and depth is regulated by the forms and length 
and number of the roots of the tooth which it sup- 
ports. 

What are the interproximal spaces and by what 
are they normally occupied ? 

The interproximal spaces are V shaped spaces 
between the points of contact and the cervical line ; 
they are normally occupied by gum tissue. 

Describe the different tissues of the teeth and 
give their location. 

Enamel, dentine, cementum and pulp. The en- 
amel covers the crown of the tooth, dentine forms the 
body of the tooth and is intermediate in position be- 
tween the enamel and pulp ; the pulp occupies the 
central chamber of the tooth and the cementum covers 
the roots of teeth. 

Trace nerve supply of the lower teeth. 

The lower teeth are supplied by small twigs given 
off by the inferior dental nerve as it passes through 
the inferior dental canal. The inferior dental is a 



392 ANATOMY AND PHYSIOLOGY. 

branch given off by the third division of the fifth } 
after it passes through the foramen ovale. 

Describe the root of a superior central incisor. 

The root of this tooth is conical in form, its base 
is directed downward,,, the apex upward. It has three 
surfaces, mesial, distal and labial. The labial side is 
the most flattened, while the two remaining sides are 
of equal length and oval in form. 

What do you understand by the horns of the pulp 
and why is a knowledge of their existence important ? 

The horns of the pulp aie prolongations of pulp 
which penetrate the various lobes of the tooth. A 
knowledge of their existence is necessary in order to 
prevent injury to pulp in operations on the teeth. 

How do the arterial vessels in the pulp differ 
from those just outside of the apical foramen ? 

The arterial vessels in the pulp are found as a 
capillary network, composed of a layer of endothelial 
cells while those outside of the foramen are much 
larger consisting of two coats. 

What various tissues and forces hold the tooth in 
the superior maxilla ? 

They are firmly imbedded in the alveolar socket. 
There is a special development of bone closely 
moulded to the roots of the teeth. Between the roots 
of the teeth and the walls of the alveoli is the peri- 
dental membrane which is attached to root and 
alveoli. This is one of the agents which hold the 
tooth in place. 



ANATOMY AND PHYSIOLOGY. 393 

Describe the occlusal surface of a superior second 
bicuspid and the manner of formation of the sulci. 

The occlusal surface presents a central groove, 
two triangular grooves, mesial marginal ridge. Buc- 
cal grooves are shallow. The sulci are formed by the 
union of the cuspid. 

Describe the crown of a superior central incisor 
in its form and tissues. 

The crown of a superior central incisor is wedge 
shape, labial surface convex, palatal surface concave, 
composed externally of enamel under which is the 
body of the crown which is composed of dentine. 
This encloses the pulp. 

What variation occurs in a pulp chamber of a su- 
perior central incisor ? 

During the early life of the tooth, the margins 
of the chamber nearest the cutting edge, presents 
three well defined lobes. These disappear as the 
tooth grows older, and are seldom found after the 
15th year. At the time of eruption the pulp cham- 
bers form almost a perfect cone. At the tenth year the 
apical foramen is established. 

What is the difference between a sulcus and a fis= 
sure ? 

A sulcus is a short and shallow groove while a 
fissure is longer and deeper. 

What are the labial lobes of superior central 
incisor? 

The labial lobes are the three parts of the labial 



394- ANATOMY AND PHYSIOLOGY. 

surface marked off by the developmental grooves. 
They originate one from each centre of calcification. 

Describe the bone of the aveolar process ; how 
does it differ from the upper and lower dentures ? 

The alveolar process of the superior maxilla is 
formed on the lower edge of the external surface. It 
is broader behind than in front, and is divided into 
sockets for the reception of the teeth. The sockets 
are divided into compartments for the reception of 
the roots. The differences between the upper and 
lower processes are, first, the sockets are smaller ( in 
the lower, and the sockets of the molars have two 
compartments while the upper have three. 

Describe the variations in the lingual surface of a 
superior lateral incisor. 

It is subject to much variatiou and form, the 
palatal fossa may be present as a smooth unbroken con- 
cavity, or may be sub-divided by a longitudinal ridge. 
The marginal ridges are usually well pronounced, 
but the surfaces may in some cases be smooth and 
flat with absence of ridge and fossa. 

What cranial nerves supply the superficial muscles 
of the face with motion ? 

The seventh pair or facial nerves. 

To what class do the nerves which supply the 
teeth belong ? Describe their function. 

To the class of sensory nerves. They carry sen- 
sations to the brain. 

Describe the difference of the cusps of the superior 
and inferior first molars. 



ANATOMY AND PHYSIOLOGY. 



395 



The cusps of an inferior first molar are not so well 
defined as that of the superior,and in the inferior there 
are always five in number, while those in the super- 
ior have four cusps, but may have five cusps. 

With what is the surface of the gum covered ? 

Mucous membrane. 

Describe anatomically a vital cuspid tooth. 

The tooth is divided into crown, neck and root. 
The crown presents four surfaces, labial, palatal, mes- 
ial, and distal, two margins cervical and cutting edges 
and the mesial distal angle. The cusp divides the 
cutting edge into mesial and distal cutting edges, the 
neck makes a decided construction between the crown 
and root on labial and palatal sides. The root is the 
largest and longest of all of the teeth. It is cone 
shaped and rounded on labial and palatal surfaces. 

Describe the occlusal surface of a superior first 
molar. 

It presents a mesio-buccal cusp, disto-buccal 
cusp, mesio- and disto-palatal cusp, a buccal groove, 
oblique ridge, a fifth cusp at times, distal marginal 
ridge and a disto-palatal groove. 

Describe the temporo=maxillary articulation. What 
movements take place ? What muscles produce them ? 

It is a double arthrodial joint, the parts entering 
into its formation being the anterior part of the 
glenoid cavity, the eminentia articularis, the condyle 
of the lower jaw, also the internal and external lateral 



J 



9 6 ANA TO MY AND PHYSIOLOG Y. 



ligaments, the stylo-maxillary ligament, an inter-artic- 
nlar iibro-cartilage and two synovial membranes. 

The jaw is depressed by the contraction of the 
digastric, geniohyoid, mylo-hyoid, and platysma my- 
oides ; elevated by the temporal, masseter and internal 
pterygoid muscles ; moved laterally by the alternate 
contraction of the external pterygoid muscles ; moved 
anteriorly by the pterygoid and posteriorly by the 
genio-hyoid, mylo-hyoid, and posterior fibers of the 
temporal muscles. 



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